Healthcare Provider Details

I. General information

NPI: 1770561466
Provider Name (Legal Business Name): SYED SAQIB AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 W. PATRICK LANE SUITE 140
LAS VEGAS NV
89113-0270
US

IV. Provider business mailing address

6970 W. PATRICK LANE SUITE 140
LAS VEGAS NV
89113-0270
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-1717
  • Fax: 702-947-6740
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11520
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: