Basic Information
Provider Information | |||||||||
NPI: | 1467732644 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | APEX BEHAVIORAL HEALTH DEARBORN PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6 PARKLANE BLVD | ||||||||
Address2: | SUITE 695 | ||||||||
City: | DEARBORN | ||||||||
State: | MI | ||||||||
PostalCode: | 481262696 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3132718170 | ||||||||
FaxNumber: | 3132718353 | ||||||||
Practice Location | |||||||||
Address1: | 6 PARKLANE BLVD | ||||||||
Address2: | SUITE 695 | ||||||||
City: | DEARBORN | ||||||||
State: | MI | ||||||||
PostalCode: | 481262696 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3132718170 | ||||||||
FaxNumber: | 3132718353 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/19/2011 | ||||||||
LastUpdateDate: | 08/20/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | QADIR | ||||||||
AuthorizedOfficialFirstName: | GHULAM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 3132718170 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 4301040442 | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 6801067821 | 01 | MI | LICENSE | OTHER | 6801079069 | 01 | MI | LICENSE | OTHER | 6801091642 | 01 | MI | LICENSE | OTHER | 4301034895 | 01 | MI | LICENSE | OTHER | 4301055604 | 01 | MI | LICENSE | OTHER | 6301002147 | 01 | MI | LICENSE | OTHER | 6301003906 | 01 | MI | LICENSE | OTHER | 6801019436 | 01 | MI | LICENSE | OTHER | 4301040442 | 01 | MI | LICENSE | OTHER |