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General NPI Number Information
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NPI Number | 1366409658
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Entity Type | Organization
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Legal Business Name | AESTHETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES SC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | W 231 N1440 CORPORATE CT STE 201
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City | WAUKESHA
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State | WI
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Zip | 53186
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Country | US
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Telephone | 414-352-2766
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Fax | 262-896-6308
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Provider Business Mailing Address
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Address Line | W 231 N1440 CORPORATE CT STE 201
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City | WAUKESHA
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State | WI
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Zip | 53186
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Country | US
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Telephone | 414-352-2766
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Fax | 262-896-6308
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NAZIH JOHN YOUSIF
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Credential | MD
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Telephone | 414-352-2766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 24830
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License Number State | WI
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