Provider Demographics
NPI:1235302597
Name:MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:MIAMI ORTHOPAEDICS & SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-889-2554
Mailing Address - Street 1:PO BOX 643386
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3386
Mailing Address - Country:US
Mailing Address - Phone:513-889-2554
Mailing Address - Fax:513-889-2557
Practice Address - Street 1:3035 HAMILTON MASON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5307
Practice Address - Country:US
Practice Address - Phone:513-889-2554
Practice Address - Fax:513-889-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084628207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDO0271OtherMEDICARE RR
OH2840537Medicaid
OHDO0271OtherMEDICARE RR