Healthcare Provider Details

I. General information

NPI: 1588629315
Provider Name (Legal Business Name): AMJAD MUTI ALKAED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROSS PARK BLVD SUITE #106
STEUBENVILLE OH
43952-2681
US

IV. Provider business mailing address

380 SUMMIT AVE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-283-2455
  • Fax: 740-283-2044
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35070468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: