Provider Demographics
NPI:1225016256
Name:JALEEL, QUADIR (MD)
Entity Type:Individual
Prefix:DR
First Name:QUADIR
Middle Name:
Last Name:JALEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 CARPENTER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-9802
Mailing Address - Country:US
Mailing Address - Phone:313-891-8246
Mailing Address - Fax:313-891-8247
Practice Address - Street 1:3120 CARPENTER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-9802
Practice Address - Country:US
Practice Address - Phone:313-891-8246
Practice Address - Fax:313-891-8247
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQJ071705OtherBLUE CROSS LICENSE #
MIH43370Medicare UPIN