MEDICARE: KHAIRAT UDDIN AHMED 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	302F00000X	Exclusive Provider Organization	35-03-7140A	OH

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	:	1861568800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAIRAT UDDIN AHMED M.D.

Provider Business Mailing Address
First Line	:	651 S LIMESTONE ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-1965
Country	:	US
Telephone Number	:	937-328-5277
Fax Number	:	937-328-5276

Provider Business Practice Location Address
First Line	:	1 E PLEASANT ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-2201
Country	:	US
Telephone Number	:	937-328-5277
Fax Number	:	937-328-5276

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/08/2008

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