Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35519 | WI |
NPI | 1174715304 |
---|---|
Provider Name | Ramzi Richard Shehadi |
First Address | Middleton, WI 53562-5527 |
Second Address | Middleton, WI 53562-5527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2007 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34937700 | (05) | WI |