MEDICARE: DR. ASHIK NISAR AHMAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME93391	FL
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	ME93391	FL
3	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	ME93391	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	29462	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104802305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHIK NISAR AHMAD MD

Provider Business Mailing Address
First Line	:	1210 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-263-4460
Fax Number	:	239-343-6259

Provider Business Practice Location Address
First Line	:	1210 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	239-343-6260
Fax Number	:	239-343-6259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	03/26/2025

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