Provider Demographics
NPI:1659647717
Name:NISAR, SHAHBAZ SHAHID (MD)
Entity Type:Individual
Prefix:
First Name:SHAHBAZ
Middle Name:SHAHID
Last Name:NISAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:4940 W CLARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-0860
Practice Address - Country:US
Practice Address - Phone:734-971-1188
Practice Address - Fax:734-971-3658
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2020-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01084868A207Q00000X
MI4301100567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine