Provider Demographics
NPI:1336513530
Name:AHMAD R ZEIBO MD PLLC
Entity Type:Organization
Organization Name:AHMAD R ZEIBO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZEIBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-846-4517
Mailing Address - Street 1:PO BOX 87763
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0763
Mailing Address - Country:US
Mailing Address - Phone:734-846-4517
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:15450 NORTHLINE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2490
Practice Address - Country:US
Practice Address - Phone:734-720-7270
Practice Address - Fax:734-288-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty