Provider Demographics
NPI:1619305950
Name:MUSHARRAF A. NIZAMI, M.D. PC
Entity Type:Organization
Organization Name:MUSHARRAF A. NIZAMI, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-227-0293
Mailing Address - Street 1:56 CLUB MANOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1679
Mailing Address - Country:US
Mailing Address - Phone:719-584-4767
Mailing Address - Fax:
Practice Address - Street 1:56 CLUB MANOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1679
Practice Address - Country:US
Practice Address - Phone:719-584-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO414162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty