Provider Demographics
NPI:1942269022
Name:NASSIF, NINETTE A (MD)
Entity Type:Individual
Prefix:
First Name:NINETTE
Middle Name:A
Last Name:NASSIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N MAYFAIR RD
Mailing Address - Street 2:SUITE 755
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-778-1451
Mailing Address - Fax:414-778-1865
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:SUITE 755
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-778-1451
Practice Address - Fax:414-778-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31574900Medicaid
F05449Medicare UPIN
WI000101071Medicare PIN