NPIMap

Organization Active NPI

Chestnut Medicine of Wi LTD

  • Internal Medicine Physician
  • Waukesha, WI
National Provider Identifier
1043805930
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CHESTNUT MEDICINE OF WI LTD
Practice address
1451 Cleveland Ave
Waukesha, WI 53186-3876
Phone
(262) 547-2123
Fax
(262) 547-6204
NPI assigned
Mar 3, 2021
Last updated
May 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Omair Siraj
Title
Ceo
Phone
(703) 964-8199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1451 Cleveland Ave
Waukesha, WI 53186-3876

Mailing address

PO Box 33
Bedford Park, IL 60499-0033
Phone (703) 964-8199

National Provider Directory

National Provider Directory

Locations

6735 W Bradley Rd
Milwaukee, WI 53223
Phone (414) 354-3300

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1043805930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33",
            "city": "BEDFORD PARK",
            "state": "IL",
            "postal_code": "604990033",
            "telephone_number": "703-964-8199",
            "fax_number": "703-649-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 CLEVELAND AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531863876",
            "telephone_number": "262-547-2123",
            "fax_number": "262-547-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT MEDICINE OF WI LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-03",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "SIRAJ",
        "authorized_official_first_name": "OMAIR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-964-8199"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.