Provider Demographics
NPI:1770662165
Name:QADIR, GHULAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:
Last Name:QADIR
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 1:6 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
Practice Address - Country:US
Practice Address - Phone:313-271-8170
Practice Address - Fax:313-271-8353
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010404422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2100490Medicaid
MI0N15280OtherAPEX BEHAVIORAL HEALTH P.L.L.C MEDICARE PIN NO.
MIA76024Medicare UPIN
MI2100490Medicaid
MI0N15280007Medicare PIN