Provider Demographics
NPI:1144317785
Name:NIZAMI, MUSHARRAF ASHROF (MD)
Entity type:Individual
Prefix:DR
First Name:MUSHARRAF
Middle Name:ASHROF
Last Name:NIZAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56 CLUB MANOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1679
Mailing Address - Country:US
Mailing Address - Phone:719-584-4767
Mailing Address - Fax:719-584-4808
Practice Address - Street 1:56 CLUB MANOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1679
Practice Address - Country:US
Practice Address - Phone:719-584-4767
Practice Address - Fax:719-584-4808
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO414162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78324041Medicaid
CO542498Medicare PIN
COE75280Medicare UPIN