Provider Demographics
NPI:1518917491
Name:NASHED-AWAD, AMGAD (MD)
Entity type:Individual
Prefix:
First Name:AMGAD
Middle Name:
Last Name:NASHED-AWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1985 GRATIOT BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2215
Practice Address - Country:US
Practice Address - Phone:810-364-5050
Practice Address - Fax:810-364-5688
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700B510850OtherBCBS OF MI
MI4604628Medicaid
MI4604628Medicaid
MI700B510850OtherBCBS OF MI