Provider Demographics
NPI:1407800709
Name:FASSEAS, PANAYOTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PANAYOTIS
Middle Name:
Last Name:FASSEAS
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF CARDIOVASCULAR MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6633
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF CARDIOVASCULAR MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6633
Practice Address - Fax:414-805-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44746207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI028668480OtherMEDICARE PTAN
WI1407800709Medicaid
WI032973840OtherMEDICARE PTAN
007000261WOtherHUMANA
WI032973840OtherMEDICARE PTAN
WI012P 73-601Medicare PIN
WI1407800709Medicaid