Provider Demographics
NPI:1598931354
Name:HEART INSTITUTE OF WISCONSIN S.C
Entity Type:Organization
Organization Name:HEART INSTITUTE OF WISCONSIN S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAMMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-282-5105
Mailing Address - Street 1:2500 W LAYTON AVE
Mailing Address - Street 2:#200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:414-282-5105
Mailing Address - Fax:414-282-8670
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:#200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-282-5105
Practice Address - Fax:414-282-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36011207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000030350Medicare PIN
000001505Medicare PIN