Healthcare Provider Details

I. General information

NPI: 1508315680
Provider Name (Legal Business Name): IBN SINA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37868 US HIGHWAY 18
PRAIRIE DU CHIEN WI
53821-8416
US

IV. Provider business mailing address

3939 LAVISTA RD STE E-348
TUCKER GA
30084-5162
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50398
License Number StateWI

VIII. Authorized Official

Name: MUHAMMAD ALI PERVAIZ
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 914-316-4218