Healthcare Provider Details

I. General information

NPI: 1063091569
Provider Name (Legal Business Name): AHMED BAGHDADY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD STE 301
MADISON HEIGHTS MI
48071-5715
US

IV. Provider business mailing address

362 E 125TH PL
CROWN POINT IN
46307-7546
US

V. Phone/Fax

Practice location:
  • Phone: 586-576-4157
  • Fax:
Mailing address:
  • Phone: 219-689-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: