Provider Demographics
NPI:1528129020
Name:ALAM, GHAIYUR (RPT)
Entity type:Individual
Prefix:MR
First Name:GHAIYUR
Middle Name:
Last Name:ALAM
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W NINE MILE ROAD
Mailing Address - Street 2:STE D
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1779
Mailing Address - Country:US
Mailing Address - Phone:248-399-5212
Mailing Address - Fax:248-399-5256
Practice Address - Street 1:641 W NINE MILE ROAD
Practice Address - Street 2:STE D
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1779
Practice Address - Country:US
Practice Address - Phone:248-399-5212
Practice Address - Fax:248-399-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F358250OtherBCBS
MI650F358250OtherBCBS