Provider Demographics
NPI:1295074409
Name:HAMTRAMCK GENERAL MEDICAL PRACTICE PLLC
Entity type:Organization
Organization Name:HAMTRAMCK GENERAL MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOTAHAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-227-8072
Mailing Address - Street 1:9632 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3305
Mailing Address - Country:US
Mailing Address - Phone:313-871-1912
Mailing Address - Fax:313-871-1914
Practice Address - Street 1:9632 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3305
Practice Address - Country:US
Practice Address - Phone:313-871-1912
Practice Address - Fax:313-871-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089057261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care