Healthcare Provider Details

I. General information

NPI: 1134879034
Provider Name (Legal Business Name): SYED BASIT HAIDER MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 260
MILWAUKEE WI
53215-3631
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 260
MILWAUKEE WI
53215-3631
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6780
  • Fax: 414-649-6030
Mailing address:
  • Phone: 414-649-6780
  • Fax: 414-649-6030

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 State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number85853-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: