Provider Demographics
NPI:1538141254
Name:DHADLI, JASVEEN KAUR (MD)
Entity Type:Individual
Prefix:MS
First Name:JASVEEN
Middle Name:KAUR
Last Name:DHADLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-695-2900
Mailing Address - Fax:
Practice Address - Street 1:9460 S SAGINAW RD
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8207
Practice Address - Country:US
Practice Address - Phone:810-695-2900
Practice Address - Fax:810-695-4311
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010547292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4674650Medicaid
MIF66046Medicare UPIN
MI0P19200Medicare PIN