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General NPI Number Information
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NPI Number | 1144615568
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Entity Type | Organization
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Legal Business Name | IMTIAZ AHMED, M.D., LLC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 2131 N LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45503-2688
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Country | US
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Telephone | 937-342-9160
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Fax | 937-342-9159
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Provider Business Mailing Address
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Address Line | 2131 N LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45503-2688
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Country | US
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Telephone | 937-342-9160
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Fax | 937-342-9159
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Authorized Official
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Title or Position | PHYSICIAN
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Name | IMTIAZ AHMED
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Credential | M.D.
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Telephone | 937-342-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35061540
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License Number State | OH
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