MEDICARE: JULIO NASIM M.D.

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	207RI0200X	Infectious Disease Physician	2021006526	MO

General Provider Information

NPI Number	:	1578912788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIO NASIM M.D.

Provider Business Mailing Address
First Line	:	24 HOSPITAL AVENUE
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S FREMONT AVE STE 3050
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2236
Country	:	US
Telephone Number	:	417-820-3905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	08/25/2021

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