Provider Demographics
NPI:1134344153
Name:NOUFAL, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:NOUFAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5200
Mailing Address - Fax:414-259-0469
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5200
Practice Address - Fax:414-259-0469
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2021-12-08
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Provider Licenses
StateLicense IDTaxonomies
ARE-61222084N0400X
WI606762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134344153Medicaid
WI1134344153Medicaid