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General NPI Number Information
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NPI Number | 1447469309
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Entity Type | Individual
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Provider Name | NASA-TATE NASSER LUMA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 N. 12TH STREET AURORA SINAI GERIATRIC INSTITUTE
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City | MILWAUKEE
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State | WI
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Zip | 53233
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Country | US
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Telephone | 718-308-6703
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Fax |
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Provider Business Mailing Address
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Address Line | 2919 W WISCONSIN AVE APT 705
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City | MILWAUKEE
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State | WI
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Zip | 53208-4503
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Country | US
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Telephone | 718-308-6703
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 240314-1
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License Number State | NY
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