Provider Demographics
NPI:1831230572
Name:JILANI, SYED IRFAN HAIDER (DPT)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:IRFAN HAIDER
Last Name:JILANI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3251
Mailing Address - Country:US
Mailing Address - Phone:313-945-9366
Mailing Address - Fax:313-945-0070
Practice Address - Street 1:4937 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3251
Practice Address - Country:US
Practice Address - Phone:313-945-9366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH257790OtherBCBS PIN #
MIOH257790OtherBCBS PIN #