Provider Demographics
NPI:1003988817
Name:JAMIL, SHAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:JAMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:44038 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5035
Mailing Address - Country:US
Mailing Address - Phone:248-333-7100
Mailing Address - Fax:248-858-7224
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:STE 405
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5036
Practice Address - Country:US
Practice Address - Phone:248-333-7100
Practice Address - Fax:248-858-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010414972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1371228Medicaid
MI1371228Medicaid
MIA77198Medicare UPIN