Individual
ASIF NISAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 18TH STREET, SUITE 200, LAKE CHARLES, LA 70601-5874
(337) 439-5369
(337) 436-9998
Mailing address
300 18TH STREET, SUITE 200, LAKE CHARLES, LA 70601-5874
(337) 439-5369
(337) 436-9998
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MA72826
NJ
207RN0300X
Nephrology Physician
MA72826
NJ
207RN0300X
Nephrology Physician
Primary
MD.203470
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9116306
—
NJ
01
—
MD.203470
MEDICAL LICENSE
LA
Enumeration date
02/17/2006
Last updated
05/23/2011
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