Provider Demographics
NPI:1811492358
Name:NISAR, SAQIB (MD)
Entity type:Individual
Prefix:
First Name:SAQIB
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 1:2507 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5407
Mailing Address - Country:US
Mailing Address - Phone:815-344-2300
Mailing Address - Fax:815-344-8957
Practice Address - Street 1:2507 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5407
Practice Address - Country:US
Practice Address - Phone:815-344-2300
Practice Address - Fax:815-344-8957
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.115539207R00000X
IL036156057207R00000X, 208M00000X, 207RG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program