Provider Demographics
NPI:1205349529
Name:BABAR SANAULLAH MD LLC
Entity type:Organization
Organization Name:BABAR SANAULLAH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-485-0151
Mailing Address - Street 1:3743 SULPHUR SPRING ROAD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2627
Mailing Address - Country:US
Mailing Address - Phone:616-485-0151
Mailing Address - Fax:567-315-8893
Practice Address - Street 1:600 N BRUSH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1402
Practice Address - Country:US
Practice Address - Phone:419-291-8447
Practice Address - Fax:419-479-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35125485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty