Provider Demographics
NPI:1558983692
Name:BEYDOUN, AHMED MICHAEL
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:MICHAEL
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 W CENTER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2151
Mailing Address - Country:US
Mailing Address - Phone:989-895-4625
Mailing Address - Fax:989-895-4626
Practice Address - Street 1:1458 W CENTER RD STE 1
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2151
Practice Address - Country:US
Practice Address - Phone:989-895-4625
Practice Address - Fax:989-895-4626
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine