Healthcare Provider Details

I. General information

NPI: 1366409658
Provider Name (Legal Business Name): AESTHETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W 231 N1440 CORPORATE CT STE 201
WAUKESHA WI
53186
US

IV. Provider business mailing address

W 231 N1440 CORPORATE CT STE 201
WAUKESHA WI
53186
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-2766
  • Fax: 262-896-6308
Mailing address:
  • Phone: 414-352-2766
  • Fax: 262-896-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number24830
License Number StateWI

VIII. Authorized Official

Name: MR. NAZIH JOHN YOUSIF
Title or Position: PRESIDENT
Credential: MD
Phone: 414-352-2766