Provider Demographics
NPI:1245217603
Name:AHMED, ADEEB (MD)
Entity Type:Individual
Prefix:
First Name:ADEEB
Middle Name:
Last Name:AHMED
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7261
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:1840 MEDICAL CENTER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3237
Practice Address - Country:US
Practice Address - Phone:615-867-5028
Practice Address - Fax:615-867-6650
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094634207RC0000X, 207RI0011X
TN60191207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094634Medicaid
ILK10750Medicare PIN
ILK38357Medicare PIN
IL036094634Medicaid