MEDICARE: DR. NUZHAT NISAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	105226	MO

General Provider Information

NPI Number	:	1790730554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NUZHAT NISAR M.D.

Provider Business Mailing Address
First Line	:	2954 HIGHWAY K
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-7861
Country	:	US
Telephone Number	:	636-978-1772
Fax Number	:	636-978-2589

Provider Business Practice Location Address
First Line	:	2954 HIGHWAY K
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-7861
Country	:	US
Telephone Number	:	636-978-1772
Fax Number	:	636-978-2589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/10/2012

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