Provider Demographics
NPI:1275525933
Name:AHMED, MUHAMMAD ALTAF (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:ALTAF
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 1:825 SECOND AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-782-0151
Mailing Address - Fax:270-782-7528
Practice Address - Street 1:1623 NASHVILLE ST
Practice Address - Street 2:STE 204 AND 205
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276
Practice Address - Country:US
Practice Address - Phone:270-726-1785
Practice Address - Fax:270-726-2278
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31168207RC0200X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64311681Medicaid
KYG48669Medicare UPIN
KY697003Medicare PIN
KY0697003Medicare ID - Type Unspecified