Provider Demographics
NPI:1275536492
Name:AHMED, MICHELLE L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:AHMED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22792 HARRISBURG WESTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9224
Mailing Address - Country:US
Mailing Address - Phone:330-823-4000
Mailing Address - Fax:330-829-2919
Practice Address - Street 1:22792 HARRISBURG WESTVILLE RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-9224
Practice Address - Country:US
Practice Address - Phone:330-823-4000
Practice Address - Fax:330-829-2919
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007803A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327431Medicaid
H59612Medicare UPIN
OHAH408029Medicare ID - Type Unspecified