Provider Demographics
NPI:1356370944
Name:AHMED, TAZEEN (MD)
Entity type:Individual
Prefix:
First Name:TAZEEN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7609
Mailing Address - Country:US
Mailing Address - Phone:989-891-9000
Mailing Address - Fax:989-891-9876
Practice Address - Street 1:2110 16TH ST
Practice Address - Street 2:STE. 4
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7609
Practice Address - Country:US
Practice Address - Phone:989-891-9000
Practice Address - Fax:989-891-9876
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066513207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588986996Medicaid
MI1588986996Medicaid
I55639Medicare UPIN