Healthcare Provider Details

I. General information

NPI: 1902772619
Provider Name (Legal Business Name): AHMAD ANEEQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4306
US

IV. Provider business mailing address

802 N ANN ST
LANCASTER PA
17602-2152
US

V. Phone/Fax

Practice location:
  • Phone: 405-784-5842
  • Fax:
Mailing address:
  • Phone: 405-591-4875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number46584
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: