Provider Demographics
NPI:1063489516
Name:S SAQIB AHMAD MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:S SAQIB AHMAD MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:SAQIB
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-372-6575
Mailing Address - Street 1:9424 VALLEY HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0151
Mailing Address - Country:US
Mailing Address - Phone:702-869-9076
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:7700 LAS VEGAS BLVD S
Practice Address - Street 2:8
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1757
Practice Address - Country:US
Practice Address - Phone:702-337-2657
Practice Address - Fax:702-382-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS13287OtherSTATE PHARMACY LICENSE
NVBA9286837OtherDEA
NVCS13287OtherSTATE PHARMACY LICENSE
NV101964Medicare ID - Type UnspecifiedCORPORATION
NVBA9286837OtherDEA