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NPI Code Detail

MEDICARE: DR. AHMED A. KOLKAILAH M.D.

MEDICARE: DR. AHMED A. KOLKAILAH M.D.
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
1208M00000XHospitalist Physician036-152646IL
2207R00000XInternal Medicine Physician036-152646IL
3207R00000XInternal Medicine Physician4301516899MI
4207RC0000XCardiovascular Disease Physician4301516899MI

General Provider Information

NPI Number : 1275069718
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AHMED A. KOLKAILAH M.D.
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number : 800-999-5829
Fax Number : 313-876-1305
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD # K-14
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-874-4497
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 05/26/2026

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