Healthcare Provider Details

I. General information

NPI: 1730418831
Provider Name (Legal Business Name): NADEEM ULLAH MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SUMMIT AVE STE B
JACKSON MI
49201-2465
US

IV. Provider business mailing address

1701 LAKE LANSING RD STE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-1225
  • Fax: 517-768-1250
Mailing address:
  • Phone: 517-485-9676
  • Fax: 517-485-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301068267
License Number StateMI

VIII. Authorized Official

Name: KRISTINA ROWE
Title or Position: CREDENTIALING
Credential:
Phone: 517-485-0001