Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301092523 | MI |
N | 111NI0900X | Internist | 4301092523 | MI |
Y | 207RH0003X | Hematology & Oncology | 62404 | WI |
NPI | 1003055302 |
---|---|
Provider Name | Abdel Hai Ismail Alqwasmi |
First Address | West Bend, WI 53095-9274 |
Second Address | West Bend, WI 53095-9274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 15/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003055302 | (05) | WI |