Provider Demographics
NPI:1467732644
Name:APEX BEHAVIORAL HEALTH DEARBORN PLLC
Entity Type:Organization
Organization Name:APEX BEHAVIORAL HEALTH DEARBORN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:
Authorized Official - Last Name:QADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-271-8170
Mailing Address - Street 1:6 PARKLANE BLVD
Mailing Address - Street 2:SUITE 695
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2696
Mailing Address - Country:US
Mailing Address - Phone:313-271-8170
Mailing Address - Fax:313-271-8353
Practice Address - Street 1:6 PARKLANE BLVD
Practice Address - Street 2:SUITE 695
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2696
Practice Address - Country:US
Practice Address - Phone:313-271-8170
Practice Address - Fax:313-271-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010404422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801067821OtherLICENSE
MI6801079069OtherLICENSE
MI6801091642OtherLICENSE
MI4301034895OtherLICENSE
MI4301055604OtherLICENSE
MI6301002147OtherLICENSE
MI6301003906OtherLICENSE
MI6801019436OtherLICENSE
MI4301040442OtherLICENSE
MI4301034895OtherLICENSE
MI0N15280007Medicare PIN
MI6301002147OtherLICENSE
MI4301055604OtherLICENSE
MI6301003906OtherLICENSE
MI6801091642OtherLICENSE
MI6801079069OtherLICENSE
MI0N19250003Medicare PIN
MI0N18210016Medicare PIN