Provider Demographics
NPI:1518196807
Name:NASIR, SAJJAD (MD)
Entity Type:Individual
Prefix:
First Name:SAJJAD
Middle Name:
Last Name:NASIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HOSPITAL DR
Mailing Address - Street 2:STE 2009
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3320
Mailing Address - Country:US
Mailing Address - Phone:920-262-4560
Mailing Address - Fax:920-262-4887
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:NORTH HILLS HEALTH CENTER
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-2510
Practice Address - Fax:262-253-3399
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS751-L2084N0400X
MS227142084N0400X
WI627942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01923807Medicaid
MS01923807Medicaid