Provider Demographics
NPI:1104099266
Name:YAQOOB, ANEELA (MD)
Entity type:Individual
Prefix:
First Name:ANEELA
Middle Name:
Last Name:YAQOOB
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 1:3515 PARKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2315
Mailing Address - Country:US
Mailing Address - Phone:734-658-6681
Mailing Address - Fax:
Practice Address - Street 1:3515 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2315
Practice Address - Country:US
Practice Address - Phone:734-658-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075063207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99902Medicare UPIN