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General NPI Number Information
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NPI Number | 1003085846
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Entity Type | Individual
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Provider Name | NAZIH JOHN YOUSIF MD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 10554 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-5537
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Country | US
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Telephone | 414-352-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 N PORT WASHINGTON RD
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City | GLENDALE
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State | WI
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Zip | 53212-1082
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Country | US
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Telephone | 414-326-2218
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Fax | 414-326-2208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24830
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 24820
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License Number State | WI
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