Provider Demographics
NPI:1881864197
Name:SULIEMAN, ABDULLATTIEF ABDULAZIZ (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDULLATTIEF
Middle Name:ABDULAZIZ
Last Name:SULIEMAN
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-0639
Mailing Address - Country:US
Mailing Address - Phone:414-645-9711
Mailing Address - Fax:414-645-9211
Practice Address - Street 1:1672 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3426
Practice Address - Country:US
Practice Address - Phone:414-645-9711
Practice Address - Fax:414-645-9211
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51008-020208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK100110473OtherMEDICARE PTAN AGELESS
WIWI1640OtherMEDICARE PTAN
WIWI1640001 INDOtherMEDICARE PTAN
WIK400111699OtherMEDICARE PTAN AGELESS
WI1881864197Medicaid