Provider Demographics
NPI:1003372525
Name:SYED, ZIAULLAH
Entity Type:Individual
Prefix:
First Name:ZIAULLAH
Middle Name:
Last Name:SYED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 DIX HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-4030
Mailing Address - Country:US
Mailing Address - Phone:313-382-3802
Mailing Address - Fax:313-382-3804
Practice Address - Street 1:4150 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4030
Practice Address - Country:US
Practice Address - Phone:313-382-3802
Practice Address - Fax:313-382-3804
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336443126Medicaid