Provider Demographics
NPI:1679655823
Name:NEIL D JADDOU MD PC
Entity Type:Organization
Organization Name:NEIL D JADDOU MD PC
Other - Org Name:SOMERSET FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JADDOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-816-1010
Mailing Address - Street 1:1615 W BIG BEAVER RD
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
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINJ065821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH03134OtherHAP
MI0806317921OtherBCBS
MI080F339440OtherBC/BS
MI124427OtherCARE CHOICES
MI=========OtherTAX ID
MI124427OtherCARE CHOICES
MIH03134Medicare UPIN