Healthcare Provider Details

I. General information

NPI: 1003290586
Provider Name (Legal Business Name): NAWRAS ALSHOUBAKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E MAHN CT
OAK CREEK WI
53154-2155
US

IV. Provider business mailing address

335 E MAHN CT
OAK CREEK WI
53154-2155
US

V. Phone/Fax

Practice location:
  • Phone: 414-762-2020
  • Fax:
Mailing address:
  • Phone: 414-762-2020
  • Fax: 414-672-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number71716-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: