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General NPI Number Information
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NPI Number | 1598931354
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Entity Type | Organization
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Legal Business Name | HEART INSTITUTE OF WISCONSIN S.C
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 2500 W LAYTON AVE #200
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City | MILWAUKEE
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State | WI
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Zip | 53221-5420
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Country | US
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Telephone | 414-282-5105
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Fax | 414-282-8670
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Provider Business Mailing Address
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Address Line | 2500 W LAYTON AVE #200
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City | MILWAUKEE
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State | WI
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Zip | 53221-5420
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Country | US
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Telephone | 414-282-5105
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Fax | 414-282-8670
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Authorized Official
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Title or Position | OWNER
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Name | DR. SALIM M SHAMMO
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Credential | M.D.
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Telephone | 414-282-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 36011
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License Number State | WI
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