Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 73961-20 | WI |
N | 207RN0300X | Nephrologist | MT213241 | PA |
NPI | 1023533403 |
---|---|
Provider Name | Motasem Mohd F Ghazi Alkhasoneh |
First Address | Oak Creek, WI 53154-2155 |
Second Address | Oak Creek, WI 53154-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 07/12/2021 |