Provider Demographics
NPI:1689770463
Name:MOSHARRAF U. AHMED M.D. PC
Entity Type:Organization
Organization Name:MOSHARRAF U. AHMED M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHARRAF
Authorized Official - Middle Name:UDDIN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-673-7202
Mailing Address - Street 1:5784 HIGHLAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1876
Mailing Address - Country:US
Mailing Address - Phone:248-673-7202
Mailing Address - Fax:248-673-7299
Practice Address - Street 1:5784 HIGHLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1876
Practice Address - Country:US
Practice Address - Phone:248-673-7202
Practice Address - Fax:248-673-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P24640Medicare ID - Type Unspecified