Provider Demographics
NPI:1649234576
Name:JAMIL, NADEEM
Entity type:Individual
Prefix:DR
First Name:NADEEM
Middle Name:
Last Name:JAMIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132795
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2795
Mailing Address - Country:US
Mailing Address - Phone:936-273-2016
Mailing Address - Fax:936-273-2018
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2005
Practice Address - Country:US
Practice Address - Phone:936-273-2016
Practice Address - Fax:936-273-2018
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2349207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155897501Medicaid
TX40120687OtherDPS
TXL2349OtherLICENSE NUMBER
TXR29536OtherBMD RADIATION LICENSE
TXBJ5245130OtherDEA
TX155897501Medicaid
TXBJ5245130OtherDEA
TXG58349Medicare UPIN
TX8552B0Medicare PIN