Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD23403 | ME |
Y | 111NI0900X | Internist | MD23403 | ME |
NPI | 1003335670 |
---|---|
Provider Name | Fnu Kaleemullah |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-6674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 18/09/2020 |