Provider Demographics
NPI:1164410866
Name:AHMAD, ANEESA BATOOL (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:ANEESA
Middle Name:BATOOL
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD,PA
Other - Prefix:
Other - First Name:ANEESA
Other - Middle Name:
Other - Last Name:BATOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6834
Mailing Address - Country:US
Mailing Address - Phone:407-331-5437
Mailing Address - Fax:407-622-7639
Practice Address - Street 1:608 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6834
Practice Address - Country:US
Practice Address - Phone:407-331-5437
Practice Address - Fax:407-622-7639
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037194208000000X
FL37194208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065310100Medicaid
FLD85768OtherFHHS PROVIDER NUMBER
FL069285OtherAETNA PROVIDER NUMBER
FL1725955002OtherCIGNA PAL NUMBER
FL593140433OtherHUMANA PROVIDER NUMBER
FL47397OtherBLUE CROSS BLUE SHEILD
FL47397OtherBLUE CROSS BLUE SHEILD