Provider Demographics
NPI:1821031576
Name:NADEEMULLAH, MOHAMMAD (M D)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:NADEEMULLAH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S LATSON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7660
Mailing Address - Country:US
Mailing Address - Phone:810-494-6800
Mailing Address - Fax:810-229-4990
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7004
Practice Address - Country:US
Practice Address - Phone:810-494-6800
Practice Address - Fax:810-229-4990
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI057016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4661698Medicaid
MIN96790001Medicare PIN
MI4661698Medicaid
MIE92619Medicare UPIN