MEDICARE: FAREEDUDDIN AHMED 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	208100000X	Physical Medicine & Rehabilitation Physician	27155	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110025846	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598745267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAREEDUDDIN AHMED MD

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61266-0850
Country	:	US
Telephone Number	:	309-762-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W CENTRAL PARK AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1707
Country	:	US
Telephone Number	:	563-421-1000
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	04/29/2008

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