Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 35075 | WI |
NPI | 1003891250 |
---|---|
Provider Name | Aboud Affi |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Milwaukee, WI 53233-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32224500 | (05) | WI |
G28652 | (02) | WI |
P00941424 | RR MEDICARE (01) | WI |