Healthcare Provider Details

I. General information

NPI: 1346691482
Provider Name (Legal Business Name): AHMED IQBAL EDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE
SPRINGFIELD OH
45504-1842
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax: 937-325-3713
Mailing address:
  • Phone: 248-551-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301109376
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.144899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: