Provider Demographics
NPI:1730156050
Name:NAMAN, TED ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:ROBERT
Last Name:NAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAKALUB
Other - Middle Name:EDWARD
Other - Last Name:NAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1934
Mailing Address - Country:US
Mailing Address - Phone:248-336-4000
Mailing Address - Fax:248-336-9137
Practice Address - Street 1:911 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1934
Practice Address - Country:US
Practice Address - Phone:248-336-4000
Practice Address - Fax:248-336-9137
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068485208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106337422OtherBCBS IND
MI1730156050Medicaid
MI1106337422OtherBCN IND
MI1106337422OtherBCN IND
MIMI2804004Medicare PIN
MIMI2804007Medicare PIN