Healthcare Provider Details

I. General information

NPI: 1558940197
Provider Name (Legal Business Name): MUHAMMAD QAISAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

3282 COLLEGE ST
BEAUMONT TX
77701-4610
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-2101
  • Fax:
Mailing address:
  • Phone: 409-212-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74302
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: