Provider Demographics
NPI:1447218292
Name:IDREES, GHULAM (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:
Last Name:IDREES
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 1:1025 HARDING MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6315
Mailing Address - Country:US
Mailing Address - Phone:740-387-8993
Mailing Address - Fax:740-387-8320
Practice Address - Street 1:1025 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6315
Practice Address - Country:US
Practice Address - Phone:740-387-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2205054Medicaid
311098079OtherPRO NEXT
311098079OtherPHYSICIANS NON PHYSICIANS
0411335OtherUHC
311098079OtherTAX ID E
OH2205054Medicaid
353077OtherSUBMITTER NO
311098079OtherCIGNA
7451367OtherAETNA
OH000000383925OtherANTHEM
311098079OtherTAX ID
311098079OtherTAX ID E
4019935Medicare ID - Type UnspecifiedPALMETTO
000000383925OtherANTHEM
OH4019935Medicare ID - Type Unspecified