Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 61317 | WI |
NPI | 1023212289 |
---|---|
Provider Name | Dr. Hesham M Elghannam |
First Address | West Allis, WI 53227-2455 |
Second Address | West Allis, WI 53227-2455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0235677 | WA STATE LABOR & INDUSTRIES (01) | WA |
8509416 | (05) | WA |