Provider Demographics
NPI:1235228040
Name:AHMED, SYED (DPM)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3971
Mailing Address - Country:US
Mailing Address - Phone:502-804-4811
Mailing Address - Fax:
Practice Address - Street 1:3045 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7933
Practice Address - Country:US
Practice Address - Phone:270-737-3338
Practice Address - Fax:270-765-5666
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001038A213ES0103X
KY244086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200886830Medicaid
528343OtherBC/BS
KY7100038990Medicaid
KY00811002Medicare PIN
KY7100038990Medicaid
IN258420BMedicare PIN
528343OtherBC/BS