Basic Information
| Provider Information | |||||||||
| NPI: | 1881709939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAIDER-SHAH | ||||||||
| FirstName: | HAMMAD | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 15TH AVE | ||||||||
| Address2: | #180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147685430 | ||||||||
| FaxNumber: | 4147624225 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 S LAKE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CUDAHY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531103171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144894190 | ||||||||
| FaxNumber: | 4144894015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 45208-20 | WI | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 45208-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.