Provider Demographics
NPI:1104889674
Name:HUMAYUN, NASEER (MD)
Entity type:Individual
Prefix:DR
First Name:NASEER
Middle Name:
Last Name:HUMAYUN
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 1:720 W FRANKLIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1674
Mailing Address - Country:US
Mailing Address - Phone:517-784-9104
Mailing Address - Fax:517-784-9107
Practice Address - Street 1:720 W FRANKLIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1674
Practice Address - Country:US
Practice Address - Phone:517-784-9104
Practice Address - Fax:517-784-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINH033036174400000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1244495-10Medicaid
MI1244495-10Medicaid