Organization
DR MICHELLE L IYAMAH PSYCHODIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PASCAL SHARMILEE (MEDICAL BILLER)
(262) 432-0919
Entity
Organization
Contact information
Practice address
933 N MAYFAIR RD STE 101, WAUWATOSA, WI 53226-3432
(414) 551-4773
Mailing address
933 N MAYFAIR RD STE 101, WAUWATOSA, WI 53226-3432
(414) 551-4773
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004821
—
WI
Enumeration date
08/09/2018
Last updated
08/09/2018
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