Provider Demographics
NPI:1598989386
Name:AHMAD, SALAHUDDIN SALEEM (MD)
Entity type:Individual
Prefix:
First Name:SALAHUDDIN
Middle Name:SALEEM
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 LIVERNOIS ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2309
Practice Address - Country:US
Practice Address - Phone:248-336-9000
Practice Address - Fax:248-336-9230
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014057742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 2941422Medicaid
MIF32674Medicare UPIN
MI0638565Medicare ID - Type Unspecified