Provider Demographics
NPI:1235123316
Name:IMAM, SYED A (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:A
Last Name:IMAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14131 MIDWAY RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3623
Mailing Address - Country:US
Mailing Address - Phone:972-249-0200
Mailing Address - Fax:972-249-0206
Practice Address - Street 1:14131 MIDWAY RD
Practice Address - Street 2:SUITE 620
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3623
Practice Address - Country:US
Practice Address - Phone:972-249-0200
Practice Address - Fax:972-249-0206
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH81240207RC0200X
IN01048311 A207RC0200X
TXN5123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000233107OtherANTHEM
OH2338929Medicaid
G83934Medicare UPIN
OHIM4086691Medicare ID - Type Unspecified