Provider Demographics
NPI:1881677284
Name:DR K F NASSIF & ASSOC SC
Entity Type:Organization
Organization Name:DR K F NASSIF & ASSOC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-258-6880
Mailing Address - Street 1:10625 W NORTH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:414-258-6880
Mailing Address - Fax:414-258-5686
Practice Address - Street 1:10625 W NORTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-258-6880
Practice Address - Fax:414-258-5686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32789900Medicaid
WI000301770Medicare PIN
WI000801770Medicare PIN
WI000201770Medicare PIN