DR. EDGAR J MASSABNI (NPI# 1649236829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649236829 |
| Entity Type | Individual |
| Full Name | DR. EDGAR J MASSABNI |
| Credential | MD |
| Practice Address |
3100 Shore Dr Marinette WI 54143-4242 |
| Mailing Address |
744 S Webster Ave Green Bay WI 54301-3505 |
| Practice Telephone | 7157358067 |
| Practice Fax Number | 7157328224 |
| Mailing Telephone | 9204457226 |
| Mailing Fax Number | 9204457229 |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-03-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
4301093535 | MI | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
51186-20 | WI | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
51186 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | MEDICARE PTAN | 007100492 | 01 |
| Street Address |
3100 SHORE DR |
| City | MARINETTE |
| State | WI |
| Zip Code | 54143-4242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639621998 | Chaeli Greco | Physical Therapist | 3100 Shore Dr, Marinette, WI 54143-4242 | 2016-11-02 |
| 1396119426 | Emergency Physician Associates of Wisconsin Sc | Physician Assistant | 3100 Shore Dr, Marinette, WI 54143-4242 | 2015-12-01 |
| 1346632346 | Lindsay N Finch | Physician Assistant | 3100 Shore Dr, Marinette, WI 54143-4242 | 2015-02-27 |
| 1750789392 | Brian Cleven | Specialist/Technologist | 3100 Shore Dr, Marinette, WI 54143-4242 | 2014-12-14 |
| 1184027948 | Andrea Hallfrisch | Speech-Language Pathologist | 3100 Shore Dr, Rehabilitation Department, Marinette, WI 54143-4242 | 2014-10-07 |
| 1104228220 | Jena K Doemel | Dietitian, Registered | 3100 Shore Dr, Marinette, WI 54143-4242 | 2014-09-19 |
| 1306258728 | Bianca Mercedes Asan Borja | Emergency Medicine | 3100 Shore Dr, Marinette, WI 54143-4242 | 2014-05-21 |
| 1053658492 | Kara Ann Mekarski | Speech-Language Pathologist | 3100 Shore Dr, Marinette, WI 54143-4242 | 2013-01-04 |
| 1598036360 | Bay Area Medical Center, Inc | Internal Medicine | 3100 Shore Dr, Marinette, WI 54143-4242 | 2012-01-25 |
| 1144591900 | Bay Area Medical Center, Inc | Internal Medicine | 3100 Shore Dr, Marinette, WI 54143-4242 | 2012-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669966750 | Allie Parthie | Dentist | 1420 University Dr, Marinette, WI 54143 | 2018-06-21 |
| 1043730690 | Jonathan Weseman | Emergency Medicine | 3003 University Dr, Marinette, Marinette, WI 54143 | 2017-06-25 |
| 1538698618 | Meghan M Russell | Nurse Practitioner | 4061 Old Peshtigo Road, Marinette, WI 54143 | 2017-06-12 |
| 1801279435 | Stephanie Miller | Licensed Practical Nurse | W1902 State Hwy 64, Marinette, WI 54143 | 2015-07-01 |
| 1417298704 | Danielle Risner | Occupational Therapist | Luther Home 831 Pine Beach Rd, Marinette, WI 54143 | 2013-03-12 |
| 1053631903 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | W 716 County B, Ste B, Marinette, WI 54143 | 2010-06-02 |
| 1417105545 | Forefront Dermatology, S.c. | Dermatology | 3515 Murray Street, Marinette, WI 54143 | 2008-09-03 |
| 1245493352 | Judith M Ribbens | Counselor | 1557 Cleveland Ave, Marinette, WI 54143 | 2008-07-08 |
| 1538338926 | Charlene Mae Miller | Licensed Practical Nurse | 1126 Daggett, Marinette, WI 54143 | 2008-02-29 |
| 1104025519 | James Alan Boren | Family Medicine | 5926 Highway 41, Stephenson, MI 54143 | 2007-07-16 |
| Find all providers in zip 54143 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740788025 | Cardiac Cin of Milwaukee LLC | Internal Medicine | 310 E Buffalo St Ste 201, Milwaukee, WI 53202-5808 | 2018-01-31 |
| 1740710748 | Robert James Corliss | Internal Medicine | St. Vincent Fmc, 140east Cook St., Portage, WI 53901 | 2017-06-13 |
| 1669765681 | Nolan P Machernis | Internal Medicine | 2801 W Kinnickinnic River Pkwy Ste 474, Milwaukee, WI 53215-3693 | 2011-05-24 |
| 1437123049 | Harinder Singh Gill | Internal Medicine | 1111 Delafield Street, Suite 215, Waukesha, WI 53188-3403 | 2006-02-13 |
| 1912998576 | Thomas G Fenske | Internal Medicine | 2801 W. Kinnickinnic River Pkwy., Suite 925, Milwaukee, WI 53215 | 2005-11-02 |
| 1437660487 | Dr Ayhan Zia Sc | Internal Medicine | 2741 W Layton Ave, Milwaukee, WI 53221-2600 | 2017-10-17 |
| 1861734014 | Sean Michael Sliman | Internal Medicine | 2900 W Oklahoma Ave, Milwaukee, WI 53215-4330 | 2013-03-25 |
| 1730436817 | Muhammad Shahreyar | Internal Medicine | 3801 Spring St, Mount Pleasant, WI 53405 | 2012-08-08 |
| 1811216229 | Iyad Azzam | Internal Medicine | 36500 Aurora Dr, Summit, WI 53066 | 2010-05-25 |
| 1306161500 | Gaurav Tyagi | Internal Medicine | 600 Highland Ave, Madison, WI 53792-0001 | 2010-03-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.