Basic Information
Provider Information | |||||||||
NPI: | 1790983443 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AHMEDFIQI | ||||||||
FirstName: | OSMAN | ||||||||
MiddleName: | ABDULKADIR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 MICHIGAN ST NE | ||||||||
Address2: | MC845 | ||||||||
City: | GRAND RAPIDS | ||||||||
State: | MI | ||||||||
PostalCode: | 495032560 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6164866790 | ||||||||
FaxNumber: | 6164866702 | ||||||||
Practice Location | |||||||||
Address1: | 300 N PATTERSON RD | ||||||||
Address2: |   | ||||||||
City: | REED CITY | ||||||||
State: | MI | ||||||||
PostalCode: | 496778041 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6164866790 | ||||||||
FaxNumber: | 6164866702 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/04/2007 | ||||||||
LastUpdateDate: | 05/17/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 202C00000X | 0101238614 | VA | N |   | Allopathic & Osteopathic Physicians | Independent Medical Examiner |   | 207R00000X | OA091111 | MI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 700110460 | 01 | MI | BCBS | OTHER | N27530066 | 01 | MI | MEDICARE | OTHER | 1790983443 | 05 | MI |   | MEDICAID |