Provider Demographics
NPI:1245375567
Name:NISAR, ABID (MD)
Entity type:Individual
Prefix:
First Name:ABID
Middle Name:
Last Name:NISAR
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 1:2730 S SAINT PETERS PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5677
Mailing Address - Country:US
Mailing Address - Phone:314-960-1052
Mailing Address - Fax:636-685-0021
Practice Address - Street 1:2730 S SAINT PETERS PKWY STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-5677
Practice Address - Country:US
Practice Address - Phone:314-960-1052
Practice Address - Fax:636-685-0021
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069763207R00000X, 207RH0003X
MOR1D36207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00204269OtherRR MEDICARE
ILC52011Medicare UPIN
ILK14264Medicare PIN
MO024364403Medicare PIN