Provider Demographics
NPI:1114996915
Name:SAEIAN, KOOROUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:KOOROUSH
Middle Name:
Last Name:SAEIAN
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 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-549-1516
Mailing Address - Fax:262-549-0648
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-549-1516
Practice Address - Fax:262-549-0648
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29297207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31556700Medicaid
WI31556700Medicaid
WIE47090Medicare UPIN