Provider Demographics
NPI:1326072471
Name:JAMAL, MAAN (MD)
Entity Type:Individual
Prefix:
First Name:MAAN
Middle Name:
Last Name:JAMAL
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:PO BOX 8385
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-8385
Mailing Address - Country:US
Mailing Address - Phone:583-726-0340
Mailing Address - Fax:586-254-3872
Practice Address - Street 1:27550 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4505
Practice Address - Country:US
Practice Address - Phone:586-427-6620
Practice Address - Fax:586-427-6625
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI055586207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3401166Medicaid
MI3401166Medicare ID - Type Unspecified
MI3401166Medicaid