Healthcare Provider Details

I. General information

NPI: 1134004690
Provider Name (Legal Business Name): HAJIME IWASAKI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8700
  • Fax: 414-259-1522
Mailing address:
  • Phone: 414-805-8700
  • Fax: 414-259-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number85882-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: