Basic Information
| Provider Information | |||||||||
| NPI: | 1538191127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JILANI | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JILANI MD PC | ||||||||
| OtherFirstName: | MUHAMMAD | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4677 TOWNE CENTRE RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897900517 | ||||||||
| FaxNumber: | 9897900261 | ||||||||
| Practice Location | |||||||||
| Address1: | 4677 TOWNE CENTRE RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897900517 | ||||||||
| FaxNumber: | 9897900261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2507311271 | 01 | MI | BLUE CROSS PROVIDER # | OTHER | 0991195 | 01 | MI | HP PROVIDER NUMBER | OTHER | 104469793 | 05 | MI | MEDICAID | 104819882 | 05 | MI | MEDICAID | 104600549 | 05 | MI | MEDICAID | 104469819 | 05 | MI | MEDICAID | 104600558 | 05 | MI | MEDICAID |