Provider Demographics
NPI:1295900975
Name:ALA E. IMAM, M.D., P.C.
Entity type:Organization
Organization Name:ALA E. IMAM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALA
Authorized Official - Middle Name:E
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-625-3000
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2087
Mailing Address - Country:US
Mailing Address - Phone:248-625-3000
Mailing Address - Fax:248-623-2278
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-3000
Practice Address - Fax:248-623-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139592710Medicaid
MIB43349Medicare UPIN
MI3630056Medicare PIN