# CHESTNUT MEDICINE OF WI LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043805930
- **Authorized official:** OMAIR SIRAJ (CEO)
- **Authorized official phone:** (703) 964-8199

## Contact information

- **Practice address:** 1451 CLEVELAND AVE, WAUKESHA, WI 53186-3876
- **Practice address phone:** (262) 547-2123
- **Practice address fax:** (262) 547-6204
- **Mailing address:** PO BOX 33, BEDFORD PARK, IL 60499-0033
- **Mailing address phone:** (703) 964-8199
- **Mailing address fax:** (703) 649-6188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2021
- **Last updated:** 05/27/2022