MEDICARE: DR. AHMAD KADDURAH MD

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	174400000X	Specialist	4301063683	MI
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	4301063683	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376521922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD KADDURAH MD

Provider Business Mailing Address
First Line	:	PO BOX 956
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48480-0956
Country	:	US
Telephone Number	:	810-233-7103
Fax Number	:	810-257-9710

Provider Business Practice Location Address
First Line	:	1 HURLEY PLZ
Second Line	:	ATTN: PROFESSIONAL BILLING DEPT
City	:	FLINT
State	:	MI
Zip	:	48503-5902
Country	:	US
Telephone Number	:	810-262-9353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/09/2016

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