Healthcare Provider Details

I. General information

NPI: 1447799754
Provider Name (Legal Business Name): RUKAN AHMED STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N LIMESTONE ST STE 120
SPRINGFIELD OH
45503-1102
US

IV. Provider business mailing address

2967 BROOKMONT CT
HILLIARD OH
43026-7938
US

V. Phone/Fax

Practice location:
  • Phone: 937-504-8390
  • Fax:
Mailing address:
  • Phone: 937-474-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015486
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: