MEDICARE: DR. IRFAN ANSARI M.D.

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	207X00000X	Orthopaedic Surgery Physician	046032	GA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316932080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRFAN ANSARI M.D.

Provider Business Mailing Address
First Line	:	1100 NORTHSIDE FORSYTH DR
Second Line	:	SUITE 340
City	:	CUMMING
State	:	GA
Zip	:	30041-6012
Country	:	US
Telephone Number	:	770-886-8111
Fax Number	:	770-205-8539

Provider Business Practice Location Address
First Line	:	1100 NORTHSIDE FORSYTH DR
Second Line	:	SUITE 340
City	:	CUMMING
State	:	GA
Zip	:	30041-6012
Country	:	US
Telephone Number	:	770-886-8111
Fax Number	:	770-205-8539

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/12/2008

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Directions to “ DR. IRFAN ANSARI M.D.” Practice Location

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