Healthcare Provider Details

I. General information

NPI: 1053465658
Provider Name (Legal Business Name): SOFIA CAROLINA MASRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S HAMILTON ST
MADISON WI
53703-4314
US

IV. Provider business mailing address

117 S HAMILTON ST
MADISON WI
53703-4314
US

V. Phone/Fax

Practice location:
  • Phone: 248-470-6603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number71666
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60403568
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD60403568
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number71666
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: