Provider Demographics
NPI:1710148002
Name:SUFYAN, AHMED (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:SUFYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 ABBOT RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1222
Mailing Address - Country:US
Mailing Address - Phone:517-332-0100
Mailing Address - Fax:517-324-7193
Practice Address - Street 1:1500 ABBOT RD
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1222
Practice Address - Country:US
Practice Address - Phone:517-332-0100
Practice Address - Fax:517-324-7193
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301104614207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery