Healthcare Provider Details

I. General information

NPI: 1811492358
Provider Name (Legal Business Name): SAQIB NISAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 N RICHMOND RD
MCHENRY IL
60051-5407
US

IV. Provider business mailing address

2507 N RICHMOND RD
MCHENRY IL
60051-5407
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-2300
  • Fax: 815-344-8957
Mailing address:
  • Phone: 815-344-2300
  • Fax: 815-344-8957

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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number336.115539
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036156057
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036156057
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036156057
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: