Provider Demographics
NPI:1720288749
Name:QANDIL, BASIL AZMI ABDULMUTI (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:AZMI ABDULMUTI
Last Name:QANDIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9222 JOSEPH CAMPAU ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-4059
Mailing Address - Country:US
Mailing Address - Phone:313-871-8900
Mailing Address - Fax:313-871-8901
Practice Address - Street 1:9222 JOSEPH CAMPAU ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-4059
Practice Address - Country:US
Practice Address - Phone:313-871-8900
Practice Address - Fax:313-871-8901
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301087756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00832043OtherRAILROAD MEDICARE
MI0809505962OtherBCBS
MI1720288749Medicaid
MI1720288749Medicare PIN
MIP00832043OtherRAILROAD MEDICARE