Provider Demographics
NPI:1477592996
Name:ULLAH, NADEEM (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:ULLAH
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 1:200 SUMMIT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2465
Mailing Address - Country:US
Mailing Address - Phone:517-768-1225
Mailing Address - Fax:517-768-1250
Practice Address - Street 1:200 SUMMIT AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2465
Practice Address - Country:US
Practice Address - Phone:517-768-1225
Practice Address - Fax:517-768-1250
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00328380OtherRR MEDICARE
MI1003811331OtherBCBS PIN
MIP00304763OtherRR MEDICARE
MI104843618Medicaid
MI104859930Medicaid
MI7802771OtherAETNA
MI1003811331OtherBCN PIN
MIP00815449OtherRAILROAD MEDICARE
MI158148OtherGREAT LAKES
MI1477592996Medicaid
MI104843618Medicaid
MI1477592996Medicaid
MIP33730001Medicare PIN
MIP00304763OtherRR MEDICARE