MEDICARE: ESMAEL H AMJAD MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	4301078515	MI

General Provider Information

NPI Number	:	1043495864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESMAEL H AMJAD MD PC

Provider Business Mailing Address
First Line	:	33200 W 14 MILE RD
Second Line	:	STE 230
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3563
Country	:	US
Telephone Number	:	248-539-9060
Fax Number	:	248-539-9202

Provider Business Practice Location Address
First Line	:	33200 W 14 MILE RD
Second Line	:	STE 230
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3563
Country	:	US
Telephone Number	:	248-539-9060
Fax Number	:	248-539-9202

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ESMAEL H AMJAD
Credential	:	MD
Telephone Number	:	248-926-6673

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	08/22/2008

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