Healthcare Provider Details

I. General information

NPI: 1295709764
Provider Name (Legal Business Name): AMIN B KASSAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY SUITE 630
MILWAUKEE WI
53215
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 680
MILWAUKEE WI
53215-3669
US

V. Phone/Fax

Practice location:
  • Phone: 414-385-1812
  • Fax: 414-385-1898
Mailing address:
  • Phone: 414-385-1922
  • Fax: 414-385-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD063726L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number61585
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: