Provider Demographics
NPI:1255314407
Name:AHMED, SYED ZULFIQAR (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:ZULFIQAR
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 1:1009 N DIXIE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-4361
Mailing Address - Fax:270-737-7654
Practice Address - Street 1:1009 N DIXIE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-4361
Practice Address - Fax:270-737-7654
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64348089Medicaid
0406303Medicare ID - Type Unspecified
KY64348089Medicaid