Provider Demographics
NPI:1508994088
Name:WILLIAM H. NUESSE, MD AND MARY-ANN NUESSE,DO A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM H. NUESSE, MD AND MARY-ANN NUESSE,DO A MEDICAL CORPORATION
Other - Org Name:SUNRISE MULTISPECIALIST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:NUESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-771-1420
Mailing Address - Street 1:867 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3426
Mailing Address - Country:US
Mailing Address - Phone:714-771-1420
Mailing Address - Fax:714-771-6918
Practice Address - Street 1:867 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3426
Practice Address - Country:US
Practice Address - Phone:714-771-1420
Practice Address - Fax:714-771-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14903Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER