| Doctor Name: | FARZANEH MASOOLTONDKAR |
| NPI Number: | 1689811861 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 52372020 |
| Business Practice Address: | 10731 W Forest Home Ave Hales Corners, WI - 531302555 |
| Business Phone Number: | 4145294600 |
| Business Fax Number: | 4145294689 |
| Mailing Address: | 10731 West Forest Home Avenue, HALES CORNERS |
| State: | WI |
| Postal Code: | 531302555 |
| Phone Number: | 4145294600 |
| Fax Number: | 4145294689 |
| NPI Enumeration Date: | 01/09/2009 |
| NPI Last Update Date: | 06/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 52372020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |