Provider Demographics
NPI:1043218118
Name:MAHOOTCHI, AHAD (MD)
Entity Type:Individual
Prefix:
First Name:AHAD
Middle Name:
Last Name:MAHOOTCHI
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:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-1059
Mailing Address - Country:US
Mailing Address - Phone:813-779-3338
Mailing Address - Fax:813-779-3318
Practice Address - Street 1:6739 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2522
Practice Address - Country:US
Practice Address - Phone:813-779-3338
Practice Address - Fax:813-779-3318
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72135207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32672OtherBLUE SHIELD
FL32672BMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLG40232Medicare UPIN
FL4402200001Medicare NSC