Provider Demographics
NPI:1245246446
Name:ULLAH, WASEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:WASEEM
Middle Name:
Last Name:ULLAH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 SPRING ARBOR RD STE 102
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3895
Mailing Address - Country:US
Mailing Address - Phone:517-783-2612
Mailing Address - Fax:517-783-5991
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:IMAGING SERVICES
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-783-2612
Practice Address - Fax:571-783-5991
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-07-01
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Provider Licenses
StateLicense IDTaxonomies
MI43010837772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301083777OtherSTATE OF MICHIGAN MEDICAL LICENSE
MI3008228201OtherBLUE CROSS BLUE SHIELD OF MICHIGAN