Provider Demographics
NPI:1598708752
Name:NADEEM ULLAH MD
Entity Type:Organization
Organization Name:NADEEM ULLAH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-768-1225
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110C813050OtherBCBS GROUP
MI110C813050OtherBCN GROUP
MI7802771OtherAETNA
DE9653OtherRAILROAD MEDICARE
MI158148OtherGREAT LAKES
MI1598708752Medicaid
MI158148OtherGREAT LAKES
MII48053Medicare UPIN