Provider Demographics
NPI:1275859795
Name:IMAM, NABEEL MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:NABEEL
Middle Name:MUHAMMAD
Last Name:IMAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 NAVARRE AVE
Mailing Address - Street 2:201
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3223
Mailing Address - Country:US
Mailing Address - Phone:419-698-8560
Mailing Address - Fax:419-698-8570
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:201
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-698-8560
Practice Address - Fax:419-698-8570
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH123949207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGOtherAPPLIED FOR MEDICARE NUMBER IN OHIO