Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6923-15 | WI |
N | 1223D0001X | Dental Public Health | 6923-15 | WI |
NPI | 1255691697 |
---|---|
Provider Name | Dr. Murtaza Makbul Sajan |
First Address | Milwaukee, WI 53202-1591 |
Second Address | Milwaukee, WI 53202-1591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 08/06/2012 |