Individual provider Active NPI

Nauman Nisar, MD

  • Clinical Pathology/Laboratory Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1962486530
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
License
54745 Issued in KY
Practice address
2215 Fuller Rd
Ann Arbor, MI 48105-2303
Phone
(734) 845-3427
Fax
(734) 845-3207
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 54745 KY Primary

Addresses

Primary practice location

2215 Fuller Rd
Ann Arbor, MI 48105-2303

Mailing address

PO Box 44008
Jacksonville, FL 32231-4008
Phone (904) 244-4387

Other identifiers 3

IdentifierTypeStateIssuer
14S1JOtherFLBCBS
003138169AMedicaidGA
009607400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070205000637 SD Practitioner - Pathology 9032189998 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
54745KYMDClinical Pathology/Laboratory Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St. Lukes CurrentSince Jun 10, 2024 Accepting new patients
Avera St. Luke'S Current Accepting new patients
Integrated Diagnostics CurrentSince Mar 1, 2020 Accepting new patients
Avera St Lukes CurrentSince Jun 10, 2024 Accepting new patients
Pathology Associates of Sturdy Memorial Hospital Inc Past Accepting new patients
Siouxland Pathology Group SMHC Past Accepting new patients

Locations

201 E 4th St
Ste 203
South Sioux City, NE 68776
Phone (712) 389-5242

305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1962486530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-4387",
            "fax_number": "904-244-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 FULLER RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052303",
            "telephone_number": "734-845-3427",
            "fax_number": "734-845-3207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISAR",
        "first_name": "NAUMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "KY",
            "license": "54745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "14S1J",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003138169A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009607400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.