Healthcare Provider Details

I. General information

NPI: 1780411603
Provider Name (Legal Business Name): MABRUR KAMAL AHMED DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 INKSTER RD STE 104
GARDEN CITY MI
48135-2538
US

IV. Provider business mailing address

6255 INKSTER RD STE 104
GARDEN CITY MI
48135-2538
US

V. Phone/Fax

Practice location:
  • Phone: 248-590-0202
  • Fax: 248-590-0278
Mailing address:
  • Phone: 248-590-0202
  • Fax: 248-590-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4704313278
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704313278
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: