Provider Demographics
NPI:1023533403
Name:ALKHASONEH, MOTASEM MOHD F GHAZI
Entity type:Individual
Prefix:
First Name:MOTASEM
Middle Name:MOHD F GHAZI
Last Name:ALKHASONEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E MAHN CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2155
Mailing Address - Country:US
Mailing Address - Phone:717-307-1035
Mailing Address - Fax:
Practice Address - Street 1:335 E MAHN CT
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2155
Practice Address - Country:US
Practice Address - Phone:717-307-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213241207RN0300X
WI73961-20207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology