Basic Information
| Provider Information | |||||||||
| NPI: | 1326107632 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAILA AHMAD MD PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44047 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482440047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486662120 | ||||||||
| FaxNumber: | 2486662798 | ||||||||
| Practice Location | |||||||||
| Address1: | 6744 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483271667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486662120 | ||||||||
| FaxNumber: | 2486662798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | NAILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2486662120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AH062441 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4500570 | 05 | MI | MEDICAID |