Individual
NETHAUM W MIZYED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2424 S 90TH ST, WEST ALLIS, WI 53227-2455
(414) 281-4466
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5137
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100182395
—
WI
Enumeration date
03/03/2020
Last updated
10/21/2024
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