Provider Demographics
NPI:1861425720
Name:MOURAD, AHMAD AMMAR (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:AMMAR
Last Name:MOURAD
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 1:444 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3015
Mailing Address - Country:US
Mailing Address - Phone:586-773-7732
Mailing Address - Fax:
Practice Address - Street 1:15350 TRENTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2027
Practice Address - Country:US
Practice Address - Phone:734-283-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics