Basic Information
Provider Information
NPI: 1346288461
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHMAD
FirstName: AYESHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DR
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481095000
CountryCode: US
TelephoneNumber: 7349364000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2006
LastUpdateDate: 07/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207SG0202X4301082840MIN Allopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
208000000X4301082840MIN Allopathic & Osteopathic PhysiciansPediatrics 
207SG0201X4301082840MIY Allopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)

No ID Information.


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