Provider Demographics
NPI:1982795126
Name:TOMA, NABEEL (MD)
Entity type:Individual
Prefix:
First Name:NABEEL
Middle Name:
Last Name:TOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 JUNCTION ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2110
Mailing Address - Country:US
Mailing Address - Phone:313-841-5500
Mailing Address - Fax:313-841-5501
Practice Address - Street 1:1700 JUNCTION ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2110
Practice Address - Country:US
Practice Address - Phone:313-841-5500
Practice Address - Fax:313-841-5501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4685690Medicaid
MI3508234791OtherBCBS OF MICHIGAN
MIG54965Medicare UPIN
MIP09460001Medicare ID - Type Unspecified