Provider Demographics
NPI:1013359173
Name:AHMAD, SAJJAD (MD)
Entity Type:Individual
Prefix:
First Name:SAJJAD
Middle Name:
Last Name:AHMAD
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 1:5514 CORPORATE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7763
Mailing Address - Country:US
Mailing Address - Phone:816-271-1221
Mailing Address - Fax:816-279-7794
Practice Address - Street 1:5514 CORPORATE DR STE 150
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7763
Practice Address - Country:US
Practice Address - Phone:816-271-1221
Practice Address - Fax:816-279-7794
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
MO2018038482207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program