Healthcare Provider Details

I. General information

NPI: 1235052788
Provider Name (Legal Business Name): SAJJAD ALI MOHAMMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N MILWAUKEE ST STE 300
MILWAUKEE WI
53202-3712
US

IV. Provider business mailing address

790 N MILWAUKEE ST STE 300
MILWAUKEE WI
53202-3712
US

V. Phone/Fax

Practice location:
  • Phone: 312-221-8442
  • Fax:
Mailing address:
  • Phone: 312-221-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: