Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 24830 | WI |
N | 208600000X | Surgeon | 24830 | WI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 24820 | WI |
NPI | 1003085846 |
---|---|
Provider Name | Nazih John Yousif |
First Address | Glendale, WI 53212-1082 |
Second Address | Mequon, WI 53092-5537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2008 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B57789 | (02) | WI |