Provider Demographics
NPI:1922206259
Name:ANJUM, MOHAMMAD IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:IMRAN
Last Name:ANJUM
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 1:1200 DEWEY AVE
Mailing Address - Street 2:AURORA PSYCHIATRIC HOSPITAL
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213
Mailing Address - Country:US
Mailing Address - Phone:414-454-6754
Mailing Address - Fax:414-454-6789
Practice Address - Street 1:1200 DEWEY AVE
Practice Address - Street 2:AURORA PSYCHIATRIC HOSPITAL
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213
Practice Address - Country:US
Practice Address - Phone:414-454-6754
Practice Address - Fax:414-454-6789
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI552882084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01175-0119Medicare PIN