MEDICARE: MR. MIN SHICK AHN 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	207Y00000X	Otolaryngology Physician	210134	MA

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

General Provider Information

NPI Number	:	1255326112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIN SHICK AHN MD

Provider Business Mailing Address
First Line	:	67 BELMONT ST
Second Line	:	STE 103
City	:	WORCESTER
State	:	MA
Zip	:	01605-2657
Country	:	US
Telephone Number	:	508-755-8623
Fax Number	:	508-752-5231

Provider Business Practice Location Address
First Line	:	67 BELMONT ST
Second Line	:	STE 103
City	:	WORCESTER
State	:	MA
Zip	:	01605-2657
Country	:	US
Telephone Number	:	508-755-8623
Fax Number	:	508-752-5231

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/08/2007

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