Healthcare Provider Details

I. General information

NPI: 1871916031
Provider Name (Legal Business Name): FARID A AHMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W RAWSON AVE 127
OAK CREEK WI
53154-8422
US

IV. Provider business mailing address

8911 S RIDGE CROFT DR
OAK CREEK WI
53154-3945
US

V. Phone/Fax

Practice location:
  • Phone: 414-539-4328
  • Fax: 414-304-8496
Mailing address:
  • Phone: 414-350-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number61782-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61782-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: