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General NPI Number Information
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NPI Number | 1023533403
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Entity Type | Individual
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Provider Name | MOTASEM MOHD F GHAZI ALKHASONEH
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Gender | Male
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 3120 S 27TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53215-4338
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Country | US
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Telephone | 414-672-8282
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Fax | 414-672-8284
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Provider Business Mailing Address
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Address Line | 335 E MAHN CT
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City | OAK CREEK
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State | WI
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Zip | 53154-2155
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Country | US
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Telephone | 414-762-2020
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Fax | 414-672-8284
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 73961-20
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License Number State | WI
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