MEDICARE: SAQH,INC

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	261QM0850X	Adult Mental Health Clinic/Center	FS5047104	WI

General Provider Information

NPI Number	:	1497114912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAQH,INC

Provider Business Mailing Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-299-3872
Fax Number	:	414-455-1929

Provider Business Practice Location Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-299-3872
Fax Number	:	414-455-1929

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SYED Q HUSSAINI
Credential	:	M.D
Telephone Number	:	201-364-7201

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	04/11/2016

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