Provider Demographics
NPI:1912993072
Name:NADEEM, ABDUL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:NADEEM
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 1:7015 GOSLING TER
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-8027
Mailing Address - Country:US
Mailing Address - Phone:941-538-7013
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-687-1275
Practice Address - Fax:863-284-1534
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME795132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258435200Medicaid
FL258435200Medicaid
FLE3774YMedicare PIN
H11598Medicare UPIN