Basic Information
| Provider Information | |||||||||
| NPI: | 1558481333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 S LIMESTONE ST | ||||||||
| Address2: | K512 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593238178 | ||||||||
| FaxNumber: | 8592579286 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | HQ101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593238178 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 53421-020 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036.124802 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301096002 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01071011A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 49133 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 201062900 | 05 | IN | MEDICAID | KY | 05 | KY | MEDICAID |