=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598708752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NADEEM ULLAH MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SUMMIT AVE STE B
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-1225
-----------------------------------------------------
Fax | 517-768-1250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SUMMIT AVE STE B
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-1225
-----------------------------------------------------
Fax | 517-768-1250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. NADEEN ULLAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 517-768-1225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------