Healthcare Provider Details

I. General information

NPI: 1497114912
Provider Name (Legal Business Name): SAQH,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 N PORT WASHINGTON RD
MILWAUKEE WI
53212-1029
US

IV. Provider business mailing address

4111 N PORT WASHINGTON RD
MILWAUKEE WI
53212-1029
US

V. Phone/Fax

Practice location:
  • Phone: 414-299-3872
  • Fax: 414-455-1929
Mailing address:
  • Phone: 414-299-3872
  • Fax: 414-455-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberFS5047104
License Number StateWI

VIII. Authorized Official

Name: DR. SYED Q HUSSAINI
Title or Position: DIRECTOR
Credential: M.D
Phone: 201-364-7201