Provider Demographics
NPI:1750815346
Name:NASRALLA, SOPHIE M (MD (FMG))
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:M
Last Name:NASRALLA
Suffix:
Gender:F
Credentials:MD (FMG)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-0410
Mailing Address - Country:US
Mailing Address - Phone:262-641-3700
Mailing Address - Fax:262-641-3719
Practice Address - Street 1:333 W BROWN DEER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-2372
Practice Address - Country:US
Practice Address - Phone:414-351-6666
Practice Address - Fax:414-351-6999
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic