Provider Demographics
NPI:1366409658
Name:AESTHETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES SC
Entity type:Organization
Organization Name:AESTHETIC AND RECONSTRUCTIVE SURGERY ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAZIH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-352-2766
Mailing Address - Street 1:W 231 N1440 CORPORATE CT
Mailing Address - Street 2:STE 201
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:414-352-2766
Mailing Address - Fax:262-896-6308
Practice Address - Street 1:W 231 N1440 CORPORATE CT
Practice Address - Street 2:STE 201
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:414-352-2766
Practice Address - Fax:262-896-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI248302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000001539Medicare PIN
WIB57789Medicare UPIN
WI000068717Medicare PIN