MEDICARE: SIAMAK ARASSI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0401X	Addiction Medicine (Internal Medicine) Physician	41661-21	WI
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	41661	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1083680417	OTHER	WI	BLUE SHIELD

General Provider Information

NPI Number	:	1083680417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIAMAK ARASSI MD

Provider Business Mailing Address
First Line	:	19115 W CAPITOL DR
Second Line	:	117
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-2754
Country	:	US
Telephone Number	:	262-781-0240
Fax Number	:	262-373-0148

Provider Business Practice Location Address
First Line	:	19115 W CAPITOL DR
Second Line	:	117
City	:	BROOKFIELD
State	:	WI
Zip	:	53045
Country	:	US
Telephone Number	:	262-781-0240
Fax Number	:	262-373-0148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2006
Last Update Date	:	08/22/2018

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