Healthcare Provider Details

I. General information

NPI: 1992774954
Provider Name (Legal Business Name): SURAIYA JABEEN AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MAIN ST
WOODVILLE OH
43469
US

IV. Provider business mailing address

2200 JEFFERSON AVE MERCY CREDENTIALING OFFICE
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-849-2871
  • Fax: 419-849-3865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35066502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: