Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 21948 | WI |
NPI | 1316998164 |
---|---|
Provider Name | Dr. Hani S Matloub |
First Address | Milwaukee, WI 53226-3462 |
Second Address | Milwaukee, WI 53226-3462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 01/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002000126C | HUMANA (01) | |
1316998164 | (05) | WI |
B54877 | (02) |