Provider Demographics
NPI:1477554699
Name:AKBAR, SYED SHAH ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:SHAH ALI
Last Name:AKBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77000 DEPT 771255
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:313-271-3000
Mailing Address - Fax:313-271-3003
Practice Address - Street 1:16407 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2571
Practice Address - Country:US
Practice Address - Phone:313-271-3000
Practice Address - Fax:313-271-3003
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034565207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC2750OtherM-CARE
MI2803364Medicaid
MIG02484OtherBLUECARE NETWORK
MI110059180C30371OtherTRAVELERS MEDICARE
MI1559OtherCAPE HEALTH PLAN
MI204980OtherFEDERAL BLACK LUNG
MI4036151OtherAETNA
MIP71340OtherBLUECARE NETWORK
MI100178OtherGREAT LAKES HEALTH PLAN
MI110Q26434OtherBCBS
MI107217OtherCARE CHOICES
MI1559OtherCAPE HEALTH PLAN
B48165Medicare UPIN