=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316976129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART SURGERY SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 W RAVINE BAYE RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-271-8181
-----------------------------------------------------
Fax | 414-352-6186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 W RAVINE BAYE RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-271-8181
-----------------------------------------------------
Fax | 414-352-6186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | SAED F SAEDI
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 414-271-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 19408
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------