Healthcare Provider Details

I. General information

NPI: 1760203327
Provider Name (Legal Business Name): UME KALSOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 07/30/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE JACKSON MI 49201 205 N EAST AVE JACKSON MI 49201
JACKSON MI
49201-1900
US

IV. Provider business mailing address

205 N EAST AVE JACKSON MI 49201
JACKSON MI
49201-1900
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3998
  • Fax: 517-205-7050
Mailing address:
  • Phone: 517-205-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: