Healthcare Provider Details

I. General information

NPI: 1609005842
Provider Name (Legal Business Name): AHMAD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E DOWNING ST
TAHLEQUAH OK
74464-3014
US

IV. Provider business mailing address

302 E DOWNING ST
TAHLEQUAH OK
74464-3014
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-9444
  • Fax: 918-458-9445
Mailing address:
  • Phone: 918-458-9444
  • Fax: 918-458-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number23648
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. YAHYA M. AHMAD
Title or Position: OWNER
Credential: M.D.
Phone: 918-458-9994