Healthcare Provider Details

I. General information

NPI: 1982906392
Provider Name (Legal Business Name): KHADIJA AHMED MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 N LIMESTONE ST
SPRINGFIELD OH
45503-2676
US

IV. Provider business mailing address

2131 N LIMESTONE ST
SPRINGFIELD OH
45503-2676
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-9160
  • Fax: 937-342-9159
Mailing address:
  • Phone: 937-342-9160
  • Fax: 937-342-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-094335
License Number StateOH

VIII. Authorized Official

Name: KHADIJA L AHMED
Title or Position: OWNER
Credential: M.D.
Phone: 937-342-9160