Provider Demographics
NPI:1205835253
Name:ELTAKI, AHMED M (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:ELTAKI
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 1:2409 CHERRY ST
Mailing Address - Street 2:#305
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:419-251-3740
Mailing Address - Fax:419-251-3859
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062739207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0893627Medicaid
OH050020394Medicare PIN
OH0718355Medicare PIN
OHF30316Medicare UPIN
OH0718356Medicare PIN
OH0893627Medicaid