Basic Information
| Provider Information | |||||||||
| NPI: | 1366409658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AESTHETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | W 231 N1440 CORPORATE CT | ||||||||
| Address2: | STE 201 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143522766 | ||||||||
| FaxNumber: | 2628966308 | ||||||||
| Practice Location | |||||||||
| Address1: | W 231 N1440 CORPORATE CT | ||||||||
| Address2: | STE 201 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143522766 | ||||||||
| FaxNumber: | 2628966308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 10/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | YOUSIF | ||||||||
| AuthorizedOfficialFirstName: | NAZIH | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4143522766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 24830 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.