Healthcare Provider Details

I. General information

NPI: 1689778920
Provider Name (Legal Business Name): MUSTANSIR MAJEED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SHARP RD
WATERFORD WI
53185-5214
US

IV. Provider business mailing address

1001 W GLEN OAKS LN STE 105
MEQUON WI
53092-3369
US

V. Phone/Fax

Practice location:
  • Phone: 262-534-7297
  • Fax:
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301071529
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39808
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: