Healthcare Provider Details

I. General information

NPI: 1225016256
Provider Name (Legal Business Name): QUADIR JALEEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 CARPENTER ST SUITE 207
HAMTRAMCK MI
48212-9802
US

IV. Provider business mailing address

3120 CARPENTER ST SUITE 207
HAMTRAMCK MI
48212-9802
US

V. Phone/Fax

Practice location:
  • Phone: 313-891-8246
  • Fax: 313-891-8247
Mailing address:
  • Phone: 313-891-8246
  • Fax: 313-891-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301071705
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: