Ala E. Imam, M.D., P.C.
Organization Active NPI Gastroenterology Physician · Clarkston, MI
NPI 1295900975 · NPPES record last updated Apr 24, 2008
Key facts
- NPI
- 1295900975
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- Legal business name
- ALA E. IMAM, M.D., P.C.
- Practice address
- 6770 Dixie Hwy
Suite 301
Clarkston, MI 48346-2087 - Phone
- (248) 625-3000
- Fax
- (248) 623-2278
- NPI assigned
- Apr 24, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Ala E Imam
- Title
- President
- Phone
- (248) 625-3000
Practitioners 1
-
Ala Eddin Imam, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080527000766 | MI | Part B Supplier - Clinic/Group Practice | 7618046004 |
Receives reassigned benefits from 1 practitioner Practice locations: Clarkston, MI |
National Provider Directory
Locations
6770 Dixie Hwy
Ste 301
Clarkston, MI 48346
Phone (248) 625-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician |
207RG0100X | Yes |
Addresses
Primary practice location
6770 Dixie Hwy
Suite 301
Clarkston, MI 48346-2087
Mailing address
6770 Dixie Hwy
Suite 301
Clarkston, MI 48346-2087
Phone (248) 625-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 139592710 | Medicaid | MI |
Other providers in Clarkston, MI
- Kaura H. Africa
- Anthony Joseph Agrusa
- Maqsood Ahmad
- Rana-Ahsan Khurshid Ahmad
- Dominique Akawuaku
- Kristen Alarie
- David Lee Alati
- Robert Spencer Albee
- Kathryn Jayne Alexander
- Cheryl R Alfaro
All providers in Clarkston, MI · Gastroenterology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.