Healthcare Provider Details

I. General information

NPI: 1629590021
Provider Name (Legal Business Name): SHAHZEB NADEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W HURON ST
PONTIAC MI
48341-1601
US

IV. Provider business mailing address

144 S JOHNSON ST
PONTIAC MI
48341-1616
US

V. Phone/Fax

Practice location:
  • Phone: 248-857-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301112763
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: