Provider Demographics
NPI:1760434443
Name:NICOLOSI, ALFRED C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:C
Last Name:NICOLOSI
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 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2982
Mailing Address - Country:US
Mailing Address - Phone:608-756-6686
Mailing Address - Fax:608-756-6289
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2982
Practice Address - Country:US
Practice Address - Phone:608-756-6686
Practice Address - Fax:608-756-6289
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27049208G00000X
MEMD19907208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760434443Medicaid
WI1760434443Medicaid
002000128JOtherHUMANA
WI009D73-601Medicare PIN
F62529Medicare UPIN