Healthcare Provider Details

I. General information

NPI: 1376728766
Provider Name (Legal Business Name): AHMAD M MIZYED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 ELLIOTT DR
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR PO BOX 0446 - LOBBY J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8000
  • Fax: 734-712-4319
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD436627
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47508
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47508
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301106060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: