Basic Information
| Provider Information | |||||||||
| NPI: | 1710934625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | KAASHIF | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 E PRESIDENT GEORGE BUSH HWY STE 250 | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750823552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888222855 | ||||||||
| FaxNumber: | 9727641661 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754097 | ||||||||
| FaxNumber: | 2105419123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | N2901 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 212591601 | 05 | TX | MEDICAID |