Provider Demographics
NPI:1073592333
Name:AHMED, SAMEENA (MD)
Entity Type:Individual
Prefix:
First Name:SAMEENA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-324-0471
Mailing Address - Fax:563-324-2948
Practice Address - Street 1:1520 7TH STREET
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-8555
Practice Address - Fax:563-324-2948
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063289207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063289Medicaid
ILL66434Medicare PIN
IL036063289Medicaid