Provider Demographics
NPI:1801964325
Name:AHSAN, SYED M (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:AHSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:24565 HAIG ROAD
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180
Mailing Address - Country:US
Mailing Address - Phone:313-291-7800
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:24565 HAIG ROAD
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-291-7800
Practice Address - Fax:313-291-7420
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060562207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SA060562OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262220OtherBLUE CROSS-BLUE CROSS
SA060562OtherCHAMPUS-CHAMPUS
MI316351010Medicaid
MI316351010Medicaid
0H26222452Medicare ID - Type Unspecified