Healthcare Provider Details

I. General information

NPI: 1891924650
Provider Name (Legal Business Name): NICHOLAS H. TOSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 03/07/2023
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MAYFAIR RD STE 901
MILWAUKEE WI
53226-1307
US

IV. Provider business mailing address

2600 N MAYFAIR RD STE 901
MILWAUKEE WI
53226-1307
US

V. Phone/Fax

Practice location:
  • Phone: 414-774-3484
  • Fax: 414-778-3446
Mailing address:
  • Phone: 414-774-3484
  • Fax: 414-778-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number63729
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number63729
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: