Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 41661 | WI |
Y | 207RA0401X | Internist - Addiction Medicine | 41661-21 | WI |
NPI | 1083680417 |
---|---|
Provider Name | Siamak Arassi |
First Address | Brookfield, WI 53045-2754 |
Second Address | Brookfield, WI 53045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2006 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083680417 | BLUE SHIELD (01) | WI |
32527500 | (05) | WI |
H08550 | (02) | WI |