Healthcare Provider Details

I. General information

NPI: 1043135973
Provider Name (Legal Business Name): MEQUON PLASTIC SURGEONS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10554 N PORT WASHINGTON RD
MEQUON WI
53092-5537
US

IV. Provider business mailing address

10554 N PORT WASHINGTON RD
MEQUON WI
53092-5537
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-2766
  • Fax: 262-241-5816
Mailing address:
  • Phone: 414-352-2766
  • Fax: 262-241-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NAZIH JOHN YOUSIF
Title or Position: MD
Credential: MD
Phone: 414-352-2766