Basic Information
| Provider Information | |||||||||
| NPI: | 1316171705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUHAMMAD | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | TALIB | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOHAMEED | ||||||||
| OtherFirstName: | AHMED | ||||||||
| OtherMiddleName: | TALIB | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9544 RICHMOND AVE STE F | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770633834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134260027 | ||||||||
| FaxNumber: | 7135261422 | ||||||||
| Practice Location | |||||||||
| Address1: | 9544 RICHMOND AVE STE F | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770633834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134260027 | ||||||||
| FaxNumber: | 7135261422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2009 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Q7086 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 246ZS0410X | 08-227 | TX | N | 208D00000X | Q7086 | TX | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.