Provider Demographics
NPI:1326097627
Name:AHMED, SYED TANVIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:TANVIR
Last Name:AHMED
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 1:1135 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-7682
Mailing Address - Country:US
Mailing Address - Phone:601-587-1433
Mailing Address - Fax:601-587-4716
Practice Address - Street 1:29601 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1909
Practice Address - Country:US
Practice Address - Phone:734-743-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18781207Q00000X
MI4301091096207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06422064Medicaid
MS080004249Medicare PIN
MSI51676Medicare UPIN