Provider Demographics
NPI:1770643363
Name:ATTAYA, SHARIFF (MD)
Entity Type:Individual
Prefix:
First Name:SHARIFF
Middle Name:
Last Name:ATTAYA
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 1:3803 SPRING ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1660
Mailing Address - Country:US
Mailing Address - Phone:262-687-8208
Mailing Address - Fax:262-687-8262
Practice Address - Street 1:3803 SPRING ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1660
Practice Address - Country:US
Practice Address - Phone:262-687-8208
Practice Address - Fax:262-687-8262
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62727207RC0001X
IL036123224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123224Medicaid
IL1033149844OtherCDPG NPI NUMBER
IL3631498336019001OtherHFS GROUP PAYEE ID
IL036123224Medicaid
IL3631498336019001OtherHFS GROUP PAYEE ID
IL206147Medicare PIN