MEDICARE: SHAH RUKH AHMED DO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376247296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAH RUKH AHMED DO

Provider Business Mailing Address
First Line	:	1301 S CRISMON RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3767
Country	:	US
Telephone Number	:
Fax Number	:	480-358-6171

Provider Business Practice Location Address
First Line	:	10238 E HAMPTON AVE STE 301C
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3322
Country	:	US
Telephone Number	:	480-354-3200
Fax Number	:	480-354-0391

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	05/04/2026

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