Provider Demographics
NPI:1265172639
Name:AHMAD, MOHAMED AHMAD (DC)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AHMAD
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:AHMAD
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:45580 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4851
Mailing Address - Country:US
Mailing Address - Phone:833-639-6676
Mailing Address - Fax:
Practice Address - Street 1:45580 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4851
Practice Address - Country:US
Practice Address - Phone:833-639-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401248111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301401248Medicaid