Healthcare Provider Details

I. General information

NPI: 1194923060
Provider Name (Legal Business Name): ATEEQ AHMED HASEEB M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 CENTRAL PARK W STE 114
TOLEDO OH
43617-1019
US

IV. Provider business mailing address

4627 WHISTLING OAKS CT
SYLVANIA OH
43560-2295
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-2686
  • Fax: 419-517-2687
Mailing address:
  • Phone: 419-349-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301083212
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.091729
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35.091729
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number35.091729
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: