Provider Demographics
NPI:1124130539
Name:DALI AHMAD, RIAD R (MD)
Entity type:Individual
Prefix:DR
First Name:RIAD
Middle Name:R
Last Name:DALI AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 HEALTH PARK BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2558
Mailing Address - Country:US
Mailing Address - Phone:810-606-7125
Mailing Address - Fax:810-606-1620
Practice Address - Street 1:600 HEALTH PARK BLVD
Practice Address - Street 2:STE H
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2558
Practice Address - Country:US
Practice Address - Phone:810-606-7125
Practice Address - Fax:810-606-1620
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068100207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703466Medicaid
MIM23560185Medicare PIN
MIH02812Medicare UPIN
MIN72340031Medicare PIN