Provider Demographics
NPI:1972573731
Name:THAMER, JAWAD (MD)
Entity type:Individual
Prefix:
First Name:JAWAD
Middle Name:
Last Name:THAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2040 MONROE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2950
Mailing Address - Country:US
Mailing Address - Phone:313-757-7647
Mailing Address - Fax:313-757-7671
Practice Address - Street 1:2040 MONROE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2950
Practice Address - Country:US
Practice Address - Phone:313-757-7647
Practice Address - Fax:313-757-7671
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI430108367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43447Medicare UPIN
MI0N72550014Medicare UPIN