Basic Information
| Provider Information | |||||||||
| NPI: | 1194803692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASIULLAH | ||||||||
| FirstName: | MASOOD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100-15TH AVE | ||||||||
| Address2: | #180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147446589 | ||||||||
| FaxNumber: | 4147478848 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 E LAYTON AVE | ||||||||
| Address2: | |||||||||
| City: | ST FRANCIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532356053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147446589 | ||||||||
| FaxNumber: | 4147478848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26343-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.