# RISING PHOENIX HEART INSTITUTE

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

## Provider details

- **NPI number:** 1073940235
- **Authorized official:** DR. NADIA MOUSSAVI MD (PRESIDENT)
- **Authorized official phone:** (414) 541-7158

## Contact information

- **Practice address:** 2323 S 109TH ST, SUITE 195, WEST ALLIS, WI 53227-1909
- **Practice address phone:** (414) 541-7158
- **Practice address fax:** (414) 541-7514
- **Mailing address:** 2323 S 109TH ST, SUITE 195, WEST ALLIS, WI 53227-1909
- **Mailing address phone:** (414) 541-7158
- **Mailing address fax:** (414) 541-7514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 34544 | WI | Yes |

## Other

- **Enumeration date:** 10/02/2013
- **Last updated:** 10/02/2013