MEDICARE: KHANSA AHMAD M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1019208	MA
2	207RI0011X	Interventional Cardiology Physician	1019208	MA
3	207RC0000X	Cardiovascular Disease Physician	1019208	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366837007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANSA AHMAD M.D

Provider Business Mailing Address
First Line	:	960 MASSACHUSETTS AVE
Second Line	:	FL 2
City	:	BOSTON
State	:	MA
Zip	:	02118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 N CLARENDON AVE APT 508
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5749
Country	:	US
Telephone Number	:	832-477-6443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	05/18/2026

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