Organization
RISING PHOENIX HEART INSTITUTE, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NADIA MOUSSAVI MD (PRESIDENT / OWNER)
(414) 541-7158
Entity
Organization
Contact information
Practice address
2323 S 109TH ST, SUITE 195, WEST ALLIS, WI 53227-1909
(414) 541-7158
(414) 541-7514
Mailing address
2323 S 109TH ST, SUITE 195, WEST ALLIS, WI 53227-1909
(414) 541-7158
(414) 541-7514
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34544
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110200829
MEDICARE RAILROAD
WI
05
—
32454600
—
WI
Enumeration date
12/26/2007
Last updated
10/17/2013
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