Basic Information
Provider Information
NPI: 1578500799
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NIMEH
FirstName: MICHAEL
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 HIGHLAND AVE
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180208920
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6109977172
Practice Location
Address1: 2300 HIGHLAND AVE
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180208920
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6109977172
Other Information
ProviderEnumerationDate: 05/31/2006
LastUpdateDate: 12/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS-008599LPAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
001579880000905PA MEDICAID


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