Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301065663 | MI |
NPI | 1134168388 |
---|---|
Provider Name | Mutahhar Ahmad |
First Address | Southfield, MI 48033-4408 |
Second Address | Southfield, MI 48033-4408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4756764 | (05) | MI |
G84021 | (02) |