Healthcare Provider Details

I. General information

NPI: 1124539176
Provider Name (Legal Business Name): I.AHMED MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 OHIO DR
GROVE CITY OH
43123-4835
US

IV. Provider business mailing address

PO BOX 713
NEW ALBANY OH
43054-0713
US

V. Phone/Fax

Practice location:
  • Phone: 614-526-8834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ISTEAQ AHMED
Title or Position: OWNER
Credential: MD
Phone: 614-526-8834