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NPI Code Detail

MEDICARE: NUSRAT AHMED M.D.

MEDICARE:   NUSRAT  AHMED  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
12084P0800XPsychiatry Physician1741651205UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3RCAROTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U003OTHERUTEDUCATORS MUTUAL
2U006OTHERUTINTERMOUNTAIN HEALTH CARE
4U002OTHERUTDESERET MUTUAL
5U009OTHERUTCHAMPUS
6U001OTHERUTBLUE CROSS

General Provider Information

NPI Number : 1497739387
Entity Type Code : Individual
Provider Name (Legal Business Name) : NUSRAT AHMED M.D.
Provider Business Mailing Address
First Line : 46 LONE HOLW
Second Line :
City : SANDY
State : UT
Zip : 84092-5530
Country : US
Telephone Number : 801-572-0133
Fax Number : 801-539-7050
Provider Business Practice Location Address
First Line : 1020 S MAIN ST
Second Line : SUIT #100
City : SALT LAKE CITY
State : UT
Zip : 84101-3176
Country : US
Telephone Number : 801-572-0133
Fax Number : 801-539-7050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2005
Last Update Date : 08/14/2012

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Directions to “ NUSRAT AHMED M.D.” Practice Location

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