Provider Demographics
NPI:1083680417
Name:ARASSI, SIAMAK (MD)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ARASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 W CAPITOL DR
Mailing Address - Street 2:117
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2754
Mailing Address - Country:US
Mailing Address - Phone:262-781-0240
Mailing Address - Fax:262-373-0148
Practice Address - Street 1:19115 W CAPITOL DR
Practice Address - Street 2:117
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-781-0240
Practice Address - Fax:262-373-0148
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41661-21207RA0401X
WI41661207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32527500Medicaid
WI1083680417OtherBLUE SHIELD
WI014730081Medicare PIN
WI32527500Medicaid
WI1083680417OtherBLUE SHIELD