Provider Demographics
NPI:1730166901
Name:HASANOGLU, NEZIH Z (DO)
Entity type:Individual
Prefix:
First Name:NEZIH
Middle Name:Z
Last Name:HASANOGLU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 W NATIONAL AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9521
Mailing Address - Country:US
Mailing Address - Phone:262-782-5662
Mailing Address - Fax:262-782-5296
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:262-782-5662
Practice Address - Fax:262-782-5296
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25286207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30019700Medicaid
B53453Medicare UPIN
80134Medicare ID - Type Unspecified