Provider Demographics
NPI:1124011143
Name:AHMAD, HAFIZ I (MD)
Entity Type:Individual
Prefix:
First Name:HAFIZ
Middle Name:I
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 1:100 VENTURE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2600
Mailing Address - Country:US
Mailing Address - Phone:859-236-6220
Mailing Address - Fax:859-236-6675
Practice Address - Street 1:1250 BEN ALI DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8937
Practice Address - Country:US
Practice Address - Phone:859-236-6220
Practice Address - Fax:859-236-6675
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35128207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000486188OtherANTHEM
KY7100013860Medicaid
KY64010739Medicaid
H12644Medicare UPIN
KY7264Medicare PIN
KY64010739Medicaid
KY0726405Medicare PIN
KYP00365582Medicare PIN