Provider Demographics
NPI:1043365794
Name:JAMIL, LAITH HIKMET (MD)
Entity Type:Individual
Prefix:
First Name:LAITH
Middle Name:HIKMET
Last Name:JAMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1859
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:3535 W 13 MILE RD STE 248
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-1515
Practice Address - Fax:248-551-1516
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070681207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064350500Medicaid
FLAK399ZMedicare PIN