Provider Demographics
NPI:1356445522
Name:AL-AHMAD, LAMIS (MD)
Entity Type:Individual
Prefix:
First Name:LAMIS
Middle Name:
Last Name:AL-AHMAD
Suffix:
Gender:F
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:PO BOX 33726
Mailing Address - Street 2:DEPT 999305
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3726
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-991-0720
Practice Address - Fax:586-991-0723
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E009340OtherBCBSM/BCN
MI3281943Medicaid
MI080E009340OtherBCBSM/BCN
G24722Medicare UPIN