Healthcare Provider Details

I. General information

NPI: 1336727718
Provider Name (Legal Business Name): MOHAMMED ANSAR AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/22/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE PT FL 2
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax: 859-257-7706
Mailing address:
  • Phone: 859-323-5157
  • Fax: 859-323-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58542
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: