Advanced OB-GYN of Dearborn, P.C.
Organization Active NPI Clinic/Center · Canton, MI
NPI 1831430909 · NPPES record last updated Mar 13, 2013
Key facts
- NPI
- 1831430909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ADVANCED OB-GYN OF DEARBORN, P.C.
- Practice address
- 2263 Pinecroft Dr
Unit 216
Canton, MI 48188-2247 - Phone
- (501) 412-9552
- NPI assigned
- Mar 13, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Ghazala Azam Ahmed, M.D.
- Title
- President
- Phone
- (501) 412-9552
Practitioners 3
-
Anjum Bokhari, DO
-
Ghazala Azam Ahmed, M.D.
-
Lauren Elizabeth Favazza, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131007000324 | MI | Part B Supplier - Clinic/Group Practice | 2567696560 |
Receives reassigned benefits from 3 practitioners Practice locations: Dearborn, MI; Canton, MI |
National Provider Directory
Locations
2421 Monroe St
Ste 201
Dearborn, MI 48124
Phone (313) 447-0511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
2263 Pinecroft Dr
Unit 216
Canton, MI 48188-2247
Mailing address
2421 Monroe St
Dearborn, MI 48124-3043
Phone (313) 447-0511
Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2013. 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.