Healthcare Provider Details

I. General information

NPI: 1861407512
Provider Name (Legal Business Name): AMIN AFSARI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N MAYFAIR RD SUITE 300
MILWAUKEE WI
53226-1506
US

IV. Provider business mailing address

3077 N MAYFAIR RD STE 305
WAUWATOSA WI
53222-4305
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-6700
  • Fax: 414-727-1058
Mailing address:
  • Phone: 414-384-6700
  • Fax: 414-727-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34-00-8685
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number52116-21
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberU01429
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number52116-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: