Healthcare Provider Details

I. General information

NPI: 1891315008
Provider Name (Legal Business Name): MUHAMMAD AHZAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

6051 ROMA DR APT 210
SHREVEPORT LA
71105-4664
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-2326
  • Fax:
Mailing address:
  • Phone: 405-519-1592
  • Fax:

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number341693
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-15189
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: