Provider Demographics
NPI:1922089127
Name:ASLAM, NABILA (MD)
Entity Type:Individual
Prefix:
First Name:NABILA
Middle Name:
Last Name:ASLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HIWAY 95 STE 107B
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4339
Mailing Address - Country:US
Mailing Address - Phone:928-763-0433
Mailing Address - Fax:928-763-0839
Practice Address - Street 1:3015 HIWAY 95 STE 107B
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4339
Practice Address - Country:US
Practice Address - Phone:928-763-0433
Practice Address - Fax:928-763-0839
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ746208Medicaid
AZH78924Medicare UPIN
AZZ110648Medicare PIN