Provider Demographics
NPI:1174521009
Name:AHMAD, IMTIAZ (MD)
Entity type:Individual
Prefix:
First Name:IMTIAZ
Middle Name:
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 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:16420 HEALTHPARK COMMONS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-437-6670
Practice Address - Fax:239-437-8871
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0672207R00000X, 207RP1001X, 207RS0012X
FLME76783207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307272OtherAVMED
FL264114OtherWELLCARE THROUGH LEE PHO
FLP930339OtherOPTIMUM
FL264114OtherMEDICARE (WELLCARE) AND MEDICAID (STAYWELL)
FL2705354-00Medicaid
FLP01266913OtherRAILROAD MCR
FL42972OtherBCBS OF FL
FLASLC2013OtherFREEDOM HEALTH
FL7809584OtherAETNA
FL2066082OtherCIGNA
FLASLC2013OtherFREEDOM HEALTH
FL264114OtherMEDICARE (WELLCARE) AND MEDICAID (STAYWELL)