Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1001278 | WI |
NPI | 1023406139 |
---|---|
Provider Name | Omar Hussain |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2014 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023406139 | (05) | WI |