DR. MOHAMMED SOUBHI NIZAM (NPI# 1326203514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326203514 |
| Entity Type | Individual |
| Full Name | DR. MOHAMMED SOUBHI NIZAM |
| Credential | M.D. |
| Practice Address |
1055 N 500 W Ste 205 Provo UT 84604-3305 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8014298095 |
| Practice Fax Number | 8013548265 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2020-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
6955621-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201013750 | 05 | |
| IN | ANTHEM PROVIDER NUMBER | 000000705030 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1175 E 50 S Ste 241, American Fork, UT 840032849 | 8014298095 | 8013548265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326145764 | Mohammed Farrukh Nizam | Psychiatry & Neurology | 98 James St, Suite 301, Edison, NJ 08820-3902 | 2006-09-20 |
| 1407895089 | Mohammed Nizam | Obstetrics & Gynecology | 950 Park Ave, New York, NY 10028-0320 | 2006-06-06 |
| Street Address |
1055 N 500 W STE 205 |
| City | PROVO |
| State | UT |
| Zip Code | 84604-3305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124687 | Kevin Johnson | Nurse Practitioner | 1055 N 500 W Ste 205, Provo, UT 84604-3305 | 2019-10-02 |
| 1922550060 | Leslie Diane Putnam | Nurse Practitioner | 1055 N 500 W Ste 205, Provo, UT 84604-3305 | 2016-10-25 |
| 1659785640 | Stephanie Kim Annillo | Dietitian, Registered | 1055 N 500 W Ste 205, Provo, UT 84604-3305 | 2014-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346882107 | Abigail Belle Hardy | Student in an Organized Health Care Education/Training Program | 1190 900 E, Provo, UT 84604 | 2019-10-14 |
| 1386106698 | Sarah Roseman Hunt | Nurse Practitioner | 1055 N 500 W., Suite. 101, Bldg. C, Provo, UT 84604 | 2019-04-04 |
| 1255813325 | Hwigeum Jeong | Specialist/Technologist | Department of Exercise Sciences 106 Sfh Brigham Young, Provo, UT 84604 | 2018-09-05 |
| 1093203044 | Snowcap Smile Studio LLC | Dentist | 2230 N. University Pkwy Ste 8b, Provo, UT 84604 | 2018-04-25 |
| 1407359078 | Ihc Health Services Inc | Clinic/Center | 380 W Bulldog Blvd, Ste 403, Provo, UT 84604 | 2018-03-09 |
| 1902308455 | Afton Leuga | Nurse Practitioner | 395 W Bulldog Blvd., Suite 401, Provo, UT 84604 | 2018-03-01 |
| 1851807333 | Ihc Health Services Inc | Family Medicine | 380 W 1230 N, Ste 602, Provo, UT 84604 | 2017-12-20 |
| 1689180218 | Ihc Health Services Inc | Pediatrics | 395 W Bulldog Blvd Ste 703, Provo, UT 84604 | 2017-12-19 |
| 1396254165 | Nicolas Sorensen | Massage Therapist | 247 West 2230 North #201, Provo, UT 84604 | 2017-09-25 |
| 1437692241 | Cirque Lodge Inc | Substance Abuse Rehabilitation Facility | 3114 E Ida's Road, Sundance, UT 84604 | 2016-11-28 |
| Find all providers in zip 84604 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659672459 | Ihc Health Services Inc | Internal Medicine | 1134 N 500 W, Ste 103, Provo, UT 84604-6102 | 2010-11-10 |
| 1346489036 | Peak Ent Associates | Internal Medicine | 1055 N 300 W, Suite 401, Provo, UT 84604-3344 | 2009-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295351278 | Healthy Mind Set Intl Inc | Internal Medicine | 7410 S Creek Rd Ste D100, Sandy, UT 84093-6140 | 2020-06-24 |
| 1700294428 | James Craven | Internal Medicine | 30 N 1900 E Som, Department of Medicine Office of Education, Salt Lake City, UT 84132 | 2014-07-25 |
| 1710002605 | Ihc Health Services Inc | Internal Medicine | 348 E 600 S, St George, UT 84770-3949 | 2007-03-20 |
| 1467533950 | Shahzad Ahmad | Internal Medicine | 4465 S 900 E Ste 200, Salt Lake City, UT 84124-2695 | 2006-10-18 |
| 1588754063 | Debra Lynn Simmons | Internal Medicine | 615 S Arapeen Dr, Suite 100, Salt Lake City, UT 84108-1267 | 2006-10-13 |
| 1033209614 | Eliot Ashby Brinton | Internal Medicine | 421 S Wakara Way Ste 121, Salt Lake City, UT 84108-1244 | 2006-10-13 |
| 1467474676 | Bruce Ryan Brady | Internal Medicine | 470 East 3900 South, #200, Salt Lake City, UT 84107-2332 | 2006-07-24 |
| 1952327173 | Simon J Fisher | Internal Medicine | 615 S Arapeen Dr Ste 100, Salt Lake City, UT 84108-1239 | 2006-07-14 |
| 1417989971 | Alireza Falahati-nini | Internal Medicine | 470 E 3900 S, Suite 200, Salt Lake City, UT 84107 | 2006-07-07 |
| 1134162258 | Timothy E Graham | Internal Medicine | 7410 S Creek Rd Ste 100, Sandy, UT 84093-6151 | 2006-06-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.