Provider Demographics
NPI:1447237615
Name:SIDDIQUI-HAMZAVI, JABEEN (MD)
Entity type:Individual
Prefix:DR
First Name:JABEEN
Middle Name:
Last Name:SIDDIQUI-HAMZAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5662
Mailing Address - Country:US
Mailing Address - Phone:734-483-7136
Mailing Address - Fax:734-483-3422
Practice Address - Street 1:428 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5662
Practice Address - Country:US
Practice Address - Phone:734-483-7136
Practice Address - Fax:734-483-3422
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC7971OtherMCARE
MI1108128442OtherBCBS OF MI
MI126845OtherCARECHOICES
MI1004173726Medicaid
MIG99216OtherHAP
MIG99216OtherHAP
G99216Medicare UPIN