MEDICARE: DR. NILOFER NISAR M.D

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	174400000X	Specialist	4301061433	MI
2	2084N0400X	Neurology Physician	4301061433	MI

General Provider Information

NPI Number	:	1922094564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NILOFER NISAR M.D

Provider Business Mailing Address
First Line	:	34815 W MICHIGAN AVE
Second Line	:	STE. C
City	:	WAYNE
State	:	MI
Zip	:	48184-1799
Country	:	US
Telephone Number	:	734-721-4739
Fax Number	:	734-721-9448

Provider Business Practice Location Address
First Line	:	34815 W MICHIGAN AVE
Second Line	:	STE. C
City	:	WAYNE
State	:	MI
Zip	:	48184-1799
Country	:	US
Telephone Number	:	734-721-4739
Fax Number	:	734-721-9448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/15/2021

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