Healthcare Provider Details

I. General information

NPI: 1154048288
Provider Name (Legal Business Name): AHMED ELAHMADY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 LINCOLN WAY
CLINTON IA
52732-7201
US

IV. Provider business mailing address

2745 LINCOLN WAY
CLINTON IA
52732-7201
US

V. Phone/Fax

Practice location:
  • Phone: 563-505-7537
  • Fax:
Mailing address:
  • Phone: 563-244-2144
  • Fax: 563-244-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOUTAZ KOTOB
Title or Position: CLINIC MANAGER
Credential: PHD
Phone: 563-244-2144