Basic Information
| Provider Information | |||||||||
| NPI: | 1326097627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMED | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | TANVIR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1135 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396547682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015871433 | ||||||||
| FaxNumber: | 6015874716 | ||||||||
| Practice Location | |||||||||
| Address1: | 29601 E 7 MILE RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347432579 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18781 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 4301091096 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 4301091096 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 06422064 | 05 | MS | MEDICAID |