Mamoun B Al-Nouri, MD
Individual provider Active NPI Cardiovascular Disease Physician · Oshkosh, WI
NPI 1104810100 · NPPES record last updated Aug 28, 2008
Key facts
- NPI
- 1104810100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 21963 (WI)
- Practice address
- 2700 W 9TH Ave
Ste 106
Oshkosh, WI 54904-7247 - Phone
- (920) 236-1755
- NPI assigned
- Sep 6, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21963 | WI | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Cardiovascular Disease | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 21963 | WI | Yes |
Addresses
Primary practice location
2700 W 9TH Ave
Ste 106
Oshkosh, WI 54904-7247
Mailing address
2700 W 9TH Ave
Ste 106
Oshkosh, WI 54904-7247
Phone (920) 236-1755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30233300 | Medicaid | WI |
Other providers in Oshkosh, WI
- Advanced Physical Therapy & Sports Medicine SC
- Aegis Group Practice LLC
- Affordable Audiology & Hearing Service, LLC
- Chinedu Edward Ahanonu
- Awais Ahmed
- Albert L. Fisher M.D.
- Cassandra Albrecht
- Albright Homes LLC
- Crystal Kaye Alderson
- Kate Alexander
All providers in Oshkosh, WI · Cardiovascular Disease Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.