Healthcare Provider Details

I. General information

NPI: 1477563146
Provider Name (Legal Business Name): MOHAMMED K AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: M K AHMED MD

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 W WOOSTER ST STE 130
BOWLING GREEN OH
43402-2643
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1600
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-6890
  • Fax: 419-353-2415
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35046264
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: