MEDICARE: MOHAMMAD NADEEMULLAH PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1568074375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAMMAD NADEEMULLAH PLLC

Provider Business Mailing Address
First Line	:	5400 WALDENHILL CT
Second Line	:
City	:	SUPERIOR TWP
State	:	MI
Zip	:	48198-9654
Country	:	US
Telephone Number	:	734-972-3692
Fax Number	:	734-761-8787

Provider Business Practice Location Address
First Line	:	5400 WALDENHILL CT
Second Line	:
City	:	SUPERIOR TWP
State	:	MI
Zip	:	48198-9654
Country	:	US
Telephone Number	:	734-972-3692
Fax Number	:	734-761-8787

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMMED NADEEMULLAH
Credential	:	MD
Telephone Number	:	734-972-3692

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	10/20/2020

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