Provider Demographics
NPI:1043495864
Name:ESMAEL H AMJAD MD PC
Entity type:Organization
Organization Name:ESMAEL H AMJAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESMAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:AMJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-926-6673
Mailing Address - Street 1:33200 W 14 MILE RD
Mailing Address - Street 2:STE 230
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3563
Mailing Address - Country:US
Mailing Address - Phone:248-539-9060
Mailing Address - Fax:248-539-9202
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:STE 230
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3563
Practice Address - Country:US
Practice Address - Phone:248-539-9060
Practice Address - Fax:248-539-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078515207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N49890003Medicare PIN