Provider Demographics
NPI:1376512418
Name:AHMED, RUBINA (MD)
Entity Type:Individual
Prefix:
First Name:RUBINA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45599 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3082
Mailing Address - Country:US
Mailing Address - Phone:734-287-0700
Mailing Address - Fax:734-287-3200
Practice Address - Street 1:12701 TELEGRAPH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6847
Practice Address - Country:US
Practice Address - Phone:734-287-0700
Practice Address - Fax:734-287-3200
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI071462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP103159 0820084OtherBLUE CARE NETWORK
MI1108200841OtherBLUE CROSS BLUE SHIELD
MI44905554Medicaid
MIP103159 0820084OtherBLUE CARE NETWORK
MION67600Medicare ID - Type UnspecifiedMEDICARE NUMBER