MEDICARE: DR. NEIL DANIAL JADDOU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	NJ065821	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124427	OTHER	MI	CARE CHOICES
2	H03134	OTHER	MA	HAP
3	080F339440	OTHER	MI	BC/BS
4	086317921	OTHER	MI	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386634632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL DANIAL JADDOU M.D.

Provider Business Mailing Address
First Line	:	1615 W BIG BEAVER RD STE A4
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3539
Country	:	US
Telephone Number	:	248-816-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 W BIG BEAVER RD STE A4
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3539
Country	:	US
Telephone Number	:	248-816-1010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/10/2012

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