Provider Demographics
NPI:1710186705
Name:JABEEN, SARWAT (MD)
Entity Type:Individual
Prefix:
First Name:SARWAT
Middle Name:
Last Name:JABEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 SOUTHWEST FWY
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3550
Mailing Address - Country:US
Mailing Address - Phone:281-342-4216
Mailing Address - Fax:281-325-4228
Practice Address - Street 1:3123 SHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4287
Practice Address - Country:US
Practice Address - Phone:715-732-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56082-20207Q00000X
TXP0908207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000040160Medicare Oscar/Certification
MION412000018Medicare Oscar/Certification