Provider Demographics
NPI:1316250954
Name:SHABBAR SAJJAD MD SC
Entity type:Organization
Organization Name:SHABBAR SAJJAD MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHABBAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-293-3299
Mailing Address - Street 1:3046 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3826
Mailing Address - Country:US
Mailing Address - Phone:414-649-9696
Mailing Address - Fax:414-649-9698
Practice Address - Street 1:3046 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3826
Practice Address - Country:US
Practice Address - Phone:414-649-9696
Practice Address - Fax:414-649-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty