Provider Demographics
NPI:1457467342
Name:HODA, QAMRUL (MD)
Entity Type:Individual
Prefix:MR
First Name:QAMRUL
Middle Name:
Last Name:HODA
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 1:35 S JOHNSON
Mailing Address - Street 2:STE 2H
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-332-9294
Mailing Address - Fax:248-332-8830
Practice Address - Street 1:35 S JOHNSON
Practice Address - Street 2:STE 2H
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-332-9294
Practice Address - Fax:248-332-8830
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIQH033724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102128OtherCARE CHOICES
MI3506313711OtherBCBS
103444OtherGREAT LAKES HEALTH CARE
4018229OtherAETNA
B49086OtherHAP
M008405OtherTRICARE
QMXPR0021044OtherMOLINA
MI1088550Medicaid
13554OtherHEALTH PLAN OF MICHIGAN
B1570OtherMCARE
102128OtherPREFERRED CHOICES
MIP40782OtherBCN
B1570OtherMCARE
MI1088550Medicaid