Provider Demographics
NPI:1114034352
Name:MAMI, AHMED G (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:G
Last Name:MAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416925
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6925
Mailing Address - Country:US
Mailing Address - Phone:732-751-3656
Mailing Address - Fax:732-643-4406
Practice Address - Street 1:400 N 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5310
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-0400
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA087155002086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery