Healthcare Provider Details

I. General information

NPI: 1104889674
Provider Name (Legal Business Name): NASEER HUMAYUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W FRANKLIN ST SUITE ONE
JACKSON MI
49201-1674
US

IV. Provider business mailing address

720 W FRANKLIN ST SUITE ONE
JACKSON MI
49201-1674
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9104
  • Fax: 517-784-9107
Mailing address:
  • Phone: 517-784-9104
  • Fax: 517-784-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNH033036
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberNH033036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: