Healthcare Provider Details

I. General information

NPI: 1154377463
Provider Name (Legal Business Name): ANWAR AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 7TH STREET SE
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

543 7TH STREET SE
CEDAR RAPIDS IA
52401
US

V. Phone/Fax

Practice location:
  • Phone: 319-861-7600
  • Fax: 319-861-7614
Mailing address:
  • Phone: 319-861-7600
  • Fax: 319-861-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036122400
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33477
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier08100343
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS IL
# 2
Identifier93122
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK IL POS
# 3
Identifier56266
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS IA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: