Provider Demographics
NPI:1730418831
Name:NADEEM ULLAH MD PLC
Entity type:Organization
Organization Name:NADEEM ULLAH MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-485-0001
Mailing Address - Street 1:1701 LAKE LANSING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3798
Mailing Address - Country:US
Mailing Address - Phone:517-485-9676
Mailing Address - Fax:517-485-2622
Practice Address - Street 1:200 SUMMIT AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2465
Practice Address - Country:US
Practice Address - Phone:517-768-1225
Practice Address - Fax:517-768-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110C800500OtherBCN
MIDQ1127OtherRAILROAD MEDICARE
MI110C800500OtherBCBS GROUP
MI1730418831Medicaid
MIMI2632Medicare PIN