Provider Demographics
NPI:1801884358
Name:NASSIF, KAMAL F (MD)
Entity type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:F
Last Name:NASSIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10625 W NORTH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2315
Mailing Address - Country:US
Mailing Address - Phone:414-258-6880
Mailing Address - Fax:414-258-5686
Practice Address - Street 1:10625 W NORTH AVE STE 200
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2315
Practice Address - Country:US
Practice Address - Phone:414-258-6880
Practice Address - Fax:414-258-5686
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI23169207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30385200Medicaid
B55313Medicare UPIN
WI000201770Medicare ID - Type Unspecified