Provider Demographics
NPI:1891924650
Name:TOSI, NICHOLAS H (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:H
Last Name:TOSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD STE 901
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1307
Mailing Address - Country:US
Mailing Address - Phone:414-774-3484
Mailing Address - Fax:414-778-3446
Practice Address - Street 1:2600 N MAYFAIR RD STE 901
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1307
Practice Address - Country:US
Practice Address - Phone:414-774-3484
Practice Address - Fax:414-778-3446
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63729207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12552288OtherCAQH
WI63729OtherSTATE LICENSE
883853OtherAMERICAN ACADEMY OF OPHTHALMOLOGY
WI100044825Medicaid
32397OtherAMERICAN BOARD OF OPHTHALMOLOGY
FT3882176OtherDEA