Individual
ANUSHAYANTHAN ALFRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H
Contact information
Practice address
5650 N GREEN BAY AVE STE 210, GLENDALE, WI 53209-4447
(414) 431-5971
(414) 434-0354
Mailing address
2514 S 102ND ST, SUITE 120, WEST ALLIS, WI 53227-2142
(414) 777-5200
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
54326
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871765859
—
WI
Enumeration date
03/30/2008
Last updated
05/19/2022
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