Healthcare Provider Details

I. General information

NPI: 1053230383
Provider Name (Legal Business Name): AHMED ABDIRASHID AHMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N WALDOCH DR
APPLETON WI
54913-8445
US

IV. Provider business mailing address

609 N WALDOCH DR
APPLETON WI
54913-8445
US

V. Phone/Fax

Practice location:
  • Phone: 619-433-2375
  • Fax:
Mailing address:
  • Phone: 619-433-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA530-0010-2133-01
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: