Basic Information
Provider Information
NPI: 1619305950
EntityType: 2
ReplacementNPI:  
OrganizationName: MUSHARRAF A. NIZAMI, M.D. PC
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Mailing Information
Address1: 56 CLUB MANOR DR
Address2: SUITE 100
City: PUEBLO
State: CO
PostalCode: 810081679
CountryCode: US
TelephoneNumber: 7195844767
FaxNumber:  
Practice Location
Address1: 56 CLUB MANOR DR
Address2: SUITE 100
City: PUEBLO
State: CO
PostalCode: 810081679
CountryCode: US
TelephoneNumber: 7195844767
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/24/2013
LastUpdateDate: 12/26/2013
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: AHAMED
AuthorizedOfficialFirstName: JAMEEL
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AuthorizedOfficialTitleorPosition: BILLING MANAGER
AuthorizedOfficialTelephone: 8472270293
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X41416COY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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