Provider Demographics
NPI:1588994271
Name:QANDEEL, HISHAM G (MD)
Entity type:Individual
Prefix:
First Name:HISHAM
Middle Name:G
Last Name:QANDEEL
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 1:1140 E MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1806
Mailing Address - Country:US
Mailing Address - Phone:175-364-5224
Mailing Address - Fax:
Practice Address - Street 1:1140 E MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1806
Practice Address - Country:US
Practice Address - Phone:517-364-5224
Practice Address - Fax:517-364-5439
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116442208G00000X
MN54858208G00000X
WAMD60722201208G00000X
TXR9841208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020003208Medicare PIN