Provider Demographics
NPI:1992899827
Name:SYED, SUZAN MOKHAYESH (MD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:MOKHAYESH
Last Name:SYED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZAN
Other - Middle Name:
Other - Last Name:MOKHAYESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 HAGGERTY RD STE 2140
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2191
Mailing Address - Country:US
Mailing Address - Phone:248-669-5050
Mailing Address - Fax:248-669-1700
Practice Address - Street 1:2300 HAGGERTY RD STE 2140
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2191
Practice Address - Country:US
Practice Address - Phone:248-669-5050
Practice Address - Fax:248-669-1700
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675174Medicaid
MII04965Medicare UPIN
MIMI9882001Medicare PIN