Healthcare Provider Details

I. General information

NPI: 1841693710
Provider Name (Legal Business Name): MEHMUD AHMED M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N MCCLINTOCK DR SUITE 4
CHANDLER AZ
85226-3711
US

IV. Provider business mailing address

2903 E WYATT WAY
GILBERT AZ
85297-2142
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-4431
  • Fax: 480-464-2338
Mailing address:
  • Phone: 480-464-4431
  • Fax: 480-464-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number24367
License Number StateAZ

VIII. Authorized Official

Name: DR. MEHMUD AHMED
Title or Position: OWNER
Credential: M.D.
Phone: 480-464-4431