MEDICARE: DR. QAIS MOHAMMAD WAHIDI 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	A111390	CA
2	261QP2300X	Primary Care Clinic/Center	111390	CA

General Provider Information

NPI Number	:	1699931097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QAIS MOHAMMAD WAHIDI M.D

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	STE 2100
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-542-7467
Fax Number	:	916-932-4879

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	STE 2100
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-542-7467
Fax Number	:	916-932-4879

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	03/12/2020

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