Basic Information
| Provider Information | |||||||||
| NPI: | 1063489516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S SAQIB AHMAD MD A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9424 VALLEY HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891340151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028699076 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 LAS VEGAS BLVD S | ||||||||
| Address2: | 8 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891231757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023372657 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 08/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | SAQIB | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PHYSICAN | ||||||||
| AuthorizedOfficialTelephone: | 7023726575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11520 | NV | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CS13287 | 01 | NV | STATE PHARMACY LICENSE | OTHER | BA9286837 | 01 | NV | DEA | OTHER |