Provider Demographics
NPI:1386634632
Name:JADDOU, NEIL DANIAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:DANIAL
Last Name:JADDOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NEIL
Other - Middle Name:DANIAL
Other - Last Name:JADDOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1615 W BIG BEAVER RD STE A4
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3539
Mailing Address - Country:US
Mailing Address - Phone:248-816-1010
Mailing Address - Fax:
Practice Address - Street 1:1615 W BIG BEAVER RD STE A4
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3539
Practice Address - Country:US
Practice Address - Phone:248-816-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINJ065821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124427OtherCARE CHOICES
MAH03134OtherHAP
MI080F339440OtherBC/BS
MI086317921OtherBCBS
MI4535315Medicaid
MAH03134OtherHAP