1730436817 NPI number — MUHAMMAD SHAHREYAR SARKI MD

Table of content: MUHAMMAD SHAHREYAR SARKI MD (NPI 1730436817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730436817 NPI number — MUHAMMAD SHAHREYAR SARKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARKI
Provider First Name:
MUHAMMAD
Provider Middle Name:
SHAHREYAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAHREYAR
Provider Other First Name:
MUHAMMAD
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730436817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3803 SPRING ST STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53405-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-687-8770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-687-4011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  60833 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730436817 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".