Provider Demographics
NPI:1891970711
Name:JKDHADLI MD PLC
Entity type:Organization
Organization Name:JKDHADLI MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASVEEN
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:DHADLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-695-2900
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1710
Mailing Address - Country:US
Mailing Address - Phone:810-695-2900
Mailing Address - Fax:810-695-4311
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010547292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4674650Medicaid
MI0P19200Medicare PIN
F66046Medicare UPIN