Healthcare Provider Details

I. General information

NPI: 1861420184
Provider Name (Legal Business Name): H SEID ASHRAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 GLENVIEW AVENUE
WAUWATOSA WI
53213
US

IV. Provider business mailing address

4555 WEST SCHROEDER DRIVE SUITE 170
MILWAUKEE WI
53223
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-0500
  • Fax: 414-771-0363
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HEBATOLLAH S ASHRAF
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 414-771-0500