Provider Demographics
NPI:1336608165
Name:USMAIEL, IFREAH ALI
Entity Type:Individual
Prefix:
First Name:IFREAH
Middle Name:ALI
Last Name:USMAIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESTWOOD CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2888
Mailing Address - Country:US
Mailing Address - Phone:715-847-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTWOOD CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2888
Practice Address - Country:US
Practice Address - Phone:414-219-7427
Practice Address - Fax:414-219-6078
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI74950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program