Healthcare Provider Details

I. General information

NPI: 1790154185
Provider Name (Legal Business Name): AHMED SOUKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 NW FIELDING RD APT 5
TOPEKA KS
66618-2571
US

IV. Provider business mailing address

4825 NW FIELDING RD APT 5
TOPEKA KS
66618-2571
US

V. Phone/Fax

Practice location:
  • Phone: 516-853-6447
  • Fax:
Mailing address:
  • Phone: 516-853-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-46294
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-46294
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: