MEDICARE: SHABBAR SAJJAD MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	53521	WI

General Provider Information

NPI Number	:	1316250954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHABBAR SAJJAD MD SC

Provider Business Mailing Address
First Line	:	3046 S 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3826
Country	:	US
Telephone Number	:	414-649-9696
Fax Number	:	414-649-9698

Provider Business Practice Location Address
First Line	:	3046 S 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3826
Country	:	US
Telephone Number	:	414-649-9696
Fax Number	:	414-649-9698

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	SHABBAR SAJJAD
Credential	:	MD
Telephone Number	:	262-293-3299

Provider Enumeration Date	:	07/25/2010
Last Update Date	:	11/02/2023

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