Individual
NISHAT NASRULLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9000 W WISCONSIN AVE, MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Mailing address
18105 LAKEVIEW DR, UNIT 202, BROOKFIELD, WI 53045-5669
(630) 709-4750
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
63853-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720306475
—
WI
Enumeration date
05/05/2010
Last updated
06/23/2015
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