Provider Demographics
NPI:1174653513
Name:NEZIH Z. HASANOGLU, D.O., S.C.
Entity Type:Organization
Organization Name:NEZIH Z. HASANOGLU, D.O., S.C.
Other - Org Name:NEZIH Z. HASANOGLU, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEZIH
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HASANOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-782-5662
Mailing Address - Street 1:13700 W NATIONAL AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9521
Mailing Address - Country:US
Mailing Address - Phone:262-782-5662
Mailing Address - Fax:262-782-5296
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:262-782-5662
Practice Address - Fax:262-782-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30019700Medicaid
=========OtherTAX ID #
WI30019700Medicaid
B53453Medicare UPIN