Healthcare Provider Details

I. General information

NPI: 1649278110
Provider Name (Legal Business Name): IBRAHIM AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 E STROOP RD
KETTERING OH
45429-4926
US

IV. Provider business mailing address

1362 E STROOP RD
KETTERING OH
45429-4926
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-0015
  • Fax: 937-643-0016
Mailing address:
  • Phone: 937-643-0015
  • Fax: 937-643-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number207RN0300X
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: