Healthcare Provider Details

I. General information

NPI: 1245686880
Provider Name (Legal Business Name): IFRAH AHMED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-1000
US

IV. Provider business mailing address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-1000
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 414-384-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2020001820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: