Individual
SHOUKRI MINA WISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
164 WASHINGTON AVE, BATAVIA, NY 14020-2113
(585) 343-6363
(585) 343-1986
Mailing address
164 WASHINGTON AVE, BATAVIA, NY 14020-2113
(585) 343-6363
(585) 343-1986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1705271
NY
207RH0003X
Hematology & Oncology Physician
Primary
170527
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01127086
—
NY
Enumeration date
05/08/2006
Last updated
04/28/2021
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