Healthcare Provider Details

I. General information

NPI: 1861440299
Provider Name (Legal Business Name): NASIM A YACOB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E CHERRY ST
ZEELAND MI
49464
US

IV. Provider business mailing address

148 E CHERRY ST
ZEELAND MI
49464
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-1655
  • Fax: 616-772-1680
Mailing address:
  • Phone: 616-772-1655
  • Fax: 616-772-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301039695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: