1275859795 NPI number — NABEEL MUHAMMAD IMAM M.D

Table of content: NABEEL MUHAMMAD IMAM M.D (NPI 1275859795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275859795 NPI number — NABEEL MUHAMMAD IMAM M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMAM
Provider First Name:
NABEEL
Provider Middle Name:
MUHAMMAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275859795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2702 NAVARRE AVE
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
OREGON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43616-3223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-698-8560
Provider Business Mailing Address Fax Number:
419-698-8570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2702 NAVARRE AVE
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-698-8560
Provider Business Practice Location Address Fax Number:
419-698-8570
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 123949 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "APPLIED FOR MEDICARE NUMBER IN OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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