Basic Information
| Provider Information | |||||||||
| NPI: | 1588688717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYED | ||||||||
| FirstName: | NAJAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9401 GENERAL DR | ||||||||
| Address2: | UNIT 140 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481704663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344535100 | ||||||||
| FaxNumber: | 7344533538 | ||||||||
| Practice Location | |||||||||
| Address1: | 25404 GODDARD RD | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481806200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132920140 | ||||||||
| FaxNumber: | 3132923542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301060629 | MI | Y | Other Service Providers | Specialist | 207R00000X | 4301060629 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11290117 | 01 | MI | CAQH | OTHER | 4301060629 | 01 | MI | STATE LICENSE # | OTHER | 1588688717 | 01 | MI | BCBS TYPE 1 (IND) NPI # | OTHER | 4331496 | 05 | MI | MEDICAID | P29180001 | 01 | MI | MEDICARE IND PIN # | OTHER | 4301060629 | 01 | MI | CDS # | OTHER |