Provider Demographics
NPI:1336128594
Name:MIR, GHULAM NABI (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:NABI
Last Name:MIR
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 1:3939 CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5611
Mailing Address - Country:US
Mailing Address - Phone:330-753-6643
Mailing Address - Fax:330-753-3465
Practice Address - Street 1:3939 CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5611
Practice Address - Country:US
Practice Address - Phone:330-753-6643
Practice Address - Fax:330-753-3465
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0431492Medicaid
OH0431492Medicaid
OHMI0482613Medicare PIN