MEDICARE: GHULAM NABI MIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	35044634	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336128594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHULAM NABI MIR M.D.

Provider Business Mailing Address
First Line	:	3939 CLEVELAND MASSILLON RD
Second Line	:
City	:	NORTON
State	:	OH
Zip	:	44203-5611
Country	:	US
Telephone Number	:	330-753-6643
Fax Number	:	330-753-3465

Provider Business Practice Location Address
First Line	:	3939 CLEVELAND MASSILLON RD
Second Line	:
City	:	NORTON
State	:	OH
Zip	:	44203-5611
Country	:	US
Telephone Number	:	330-753-6643
Fax Number	:	330-753-3465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	04/01/2011

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