Provider Demographics
NPI:1003849001
Name:AHMADI, BAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1049
Mailing Address - Country:US
Mailing Address - Phone:863-382-0385
Mailing Address - Fax:863-402-2441
Practice Address - Street 1:7441 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1049
Practice Address - Country:US
Practice Address - Phone:863-382-0385
Practice Address - Fax:863-402-2441
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89989207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48293OtherBCBS
P00189601OtherRAILROAD MEDICARE
FL270602400Medicaid
I16190Medicare UPIN
P00189601OtherRAILROAD MEDICARE