Provider Demographics
NPI:1851457287
Name:SYED, MUSHTAQUE ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSHTAQUE
Middle Name:ALI
Last Name:SYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:947 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5625
Mailing Address - Country:US
Mailing Address - Phone:248-879-9230
Mailing Address - Fax:248-248-6743
Practice Address - Street 1:4800 CLINTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4297
Practice Address - Country:US
Practice Address - Phone:248-674-0903
Practice Address - Fax:248-674-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055989207R00000X
MIMS155989207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4393766Medicaid
MI4393766Medicaid
MION41300Medicare ID - Type Unspecified