Provider Demographics
NPI:1649251588
Name:AHMAD, FARIS K (MD)
Entity type:Individual
Prefix:DR
First Name:FARIS
Middle Name:K
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4550 INVESTMENT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6363
Mailing Address - Country:US
Mailing Address - Phone:248-267-5040
Mailing Address - Fax:248-267-5041
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:STE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6363
Practice Address - Country:US
Practice Address - Phone:248-267-5040
Practice Address - Fax:248-267-5041
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063722207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
N96510002Medicare ID - Type Unspecified
G84224Medicare UPIN