Basic Information
| Provider Information | |||||||||
| NPI: | 1922206259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANJUM | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | IMRAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 DEWEY AVE | ||||||||
| Address2: | AURORA PSYCHIATRIC HOSPITAL | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144546754 | ||||||||
| FaxNumber: | 4144546789 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 DEWEY AVE | ||||||||
| Address2: | AURORA PSYCHIATRIC HOSPITAL | ||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144546754 | ||||||||
| FaxNumber: | 4144546789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2007 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 55288 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0802X | 55288 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.