Provider Demographics
NPI:1215177357
Name:AHMED, IJAZ
Entity type:Individual
Prefix:
First Name:IJAZ
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 BENTLEY RD
Mailing Address - Street 2:APT # 203
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-893-7008
Practice Address - Street 1:5451 BENTLEY RD
Practice Address - Street 2:#203
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2176
Practice Address - Country:US
Practice Address - Phone:734-556-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist