Basic Information
| Provider Information | |||||||||
| NPI: | 1417034166 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | I AHMAD AND S AHMAD MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 NW 9TH | ||||||||
| Address2: | SUITE 4000 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052728383 | ||||||||
| FaxNumber: | 4052318745 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 NW 9TH | ||||||||
| Address2: | SUITE 4000 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052728383 | ||||||||
| FaxNumber: | 4052318745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | IFTIKHAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4052728383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 14498 | OK | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207RC0000X | 12063 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 200093970A | 05 | OK | MEDICAID |