Provider Demographics
NPI:1407803240
Name:MESROBIAN, HRAIR-GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:HRAIR-GEORGE
Middle Name:
Last Name:MESROBIAN
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 1:128 E BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5972
Mailing Address - Country:US
Mailing Address - Phone:414-331-9001
Mailing Address - Fax:414-266-1752
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3794
Practice Address - Fax:414-266-1752
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36790208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407803240Medicaid
WI32146800Medicaid
WI32146800Medicaid
C89337Medicare UPIN