Provider Demographics
NPI:1376593806
Name:SANAULLAH, BABAR (MD)
Entity Type:Individual
Prefix:
First Name:BABAR
Middle Name:
Last Name:SANAULLAH
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:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0289
Mailing Address - Country:US
Mailing Address - Phone:616-457-9000
Mailing Address - Fax:616-457-3801
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2598
Practice Address - Country:US
Practice Address - Phone:419-383-4000
Practice Address - Fax:419-383-2918
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104104781OtherBCBS
P00046081OtherRR MEDICARE
MI104491201Medicaid
P00046081OtherRR MEDICARE
G20700Medicare UPIN