MEDICARE: BABAR SANAULLAH M.D. PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1306892674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABAR SANAULLAH M.D. PLC

Provider Business Mailing Address
First Line	:	2815 MICHIGAN ST NE
Second Line	:	STE B
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-977-8000
Fax Number	:	616-977-8002

Provider Business Practice Location Address
First Line	:	2815 MICHIGAN ST NE
Second Line	:	STE B
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1266
Country	:	US
Telephone Number	:	616-977-8000
Fax Number	:	616-977-8002

Authorized Official
Title or Position	:	OWNER
Name	:	BABAR SANAULLAH
Credential	:	MD
Telephone Number	:	616-977-8000

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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