=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720249592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NINETTE A. NASSIF,M.D., S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2008
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 N MAYFAIR RD SUITE 755
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-778-1451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 N MAYFAIR RD SUITE 755
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NINETTE A NASSIF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 414-778-1451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 29531
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------