Provider Demographics
NPI:1609107465
Name:ASIF NISAR MD LLC
Entity Type:Organization
Organization Name:ASIF NISAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:NISAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-439-5369
Mailing Address - Street 1:300 18TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5874
Mailing Address - Country:US
Mailing Address - Phone:337-439-5369
Mailing Address - Fax:337-436-9998
Practice Address - Street 1:300 18TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5874
Practice Address - Country:US
Practice Address - Phone:337-439-5369
Practice Address - Fax:337-436-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203470207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty