Healthcare Provider Details

I. General information

NPI: 1184767295
Provider Name (Legal Business Name): OLA SALEH KANJ AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELLINGER ST
EAU CLAIRE WI
54703-5222
US

IV. Provider business mailing address

PO BOX 1510
EAU CLAIRE WI
54702-1510
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-5222
  • Fax:
Mailing address:
  • Phone: 715-838-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number63970
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number63970
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: