Provider Demographics
NPI:1174591028
Name:SULEIMAN, JIAB (DO)
Entity type:Individual
Prefix:
First Name:JIAB
Middle Name:
Last Name:SULEIMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 EXECUTIVE PLAZA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2793
Mailing Address - Country:US
Mailing Address - Phone:313-565-4948
Mailing Address - Fax:313-565-4989
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2793
Practice Address - Country:US
Practice Address - Phone:313-565-4948
Practice Address - Fax:313-565-4989
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013467207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63421Medicare UPIN