Healthcare Provider Details

I. General information

NPI: 1851376305
Provider Name (Legal Business Name): IFTIKHAR AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14019 S 8TH ST
PHOENIX AZ
85048-4459
US

IV. Provider business mailing address

14019 S 8TH ST
PHOENIX AZ
85048-4459
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-3737
  • Fax:
Mailing address:
  • Phone: 480-668-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number36212
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number25050
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number176536-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number25050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: