Basic Information
| Provider Information | |||||||||
| NPI: | 1053568667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLKHIR | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 WALTER ST NE STE 401 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | 5057279590 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 WALTER ST NE STE 401 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | 5057279590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 53026 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 32006 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208M00000X | 036122476 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 01070297 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | MD2021-1113 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 201040770 | 05 | IN | MEDICAID | 07576579 | 05 | NM | MEDICAID |