Organization
WATERTOWN HEART INSTITUTE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALIM M. SHAMMO M.D. (PRESIDENT)
(414) 282-5105
Entity
Organization
Contact information
Practice address
125 HOSPITAL DRIVE, WATERTOWN, WI 53098-3303
(920) 262-4449
(920) 262-4533
Mailing address
2500 LAYTON AVENUE, SUITE: 200, MILWAUKEE, WI 53221-5434
(414) 282-5105
(414) 282-8670
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36011-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32078400
—
WI
Enumeration date
01/20/2010
Last updated
05/21/2010
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