Provider Demographics
NPI:1942255849
Name:SAJJAD, IMRAN (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:SAJJAD
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 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 327
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-524-1024
Mailing Address - Fax:262-524-8767
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 327
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-524-1024
Practice Address - Fax:262-524-8767
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49181-20207R00000X, 208M00000X
WI49181-020207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34868500Medicaid
WI0028-68705Medicare PIN
WI34868500Medicaid
WIP00316515Medicare PIN
WIP01185005OtherRAILROAD MEDICARE
I54590Medicare UPIN
WI0018-30020Medicare PIN
WI007713215Medicare PIN