MEDICARE: AHMAD ALCHOMMALI 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	207P00000X	Emergency Medicine Physician	MD-29019	IA
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	18735	NE
3	207P00000X	Emergency Medicine Physician	18735	NE

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	:	1437144961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD ALCHOMMALI MD

Provider Business Mailing Address
First Line	:	631 N 8TH ST
Second Line	:
City	:	MISSOURI VALLEY
State	:	IA
Zip	:	51555-1102
Country	:	US
Telephone Number	:	712-642-2784
Fax Number	:	712-642-9259

Provider Business Practice Location Address
First Line	:	601 N 30TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-2137
Country	:	US
Telephone Number	:	402-449-4590
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	12/14/2018

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