Provider Demographics
NPI:1588742878
Name:IMAM, ALA EDDIN (MD)
Entity type:Individual
Prefix:MR
First Name:ALA
Middle Name:EDDIN
Last Name:IMAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6770 DIXIE HIGHWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-625-3000
Mailing Address - Fax:248-625-2278
Practice Address - Street 1:6770 DIXIE HIGHWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-625-3000
Practice Address - Fax:248-625-2278
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-07-13
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Provider Licenses
StateLicense IDTaxonomies
MI4301039823207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology