Provider Demographics
NPI:1275587453
Name:JAKDA, AHMED I (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:I
Last Name:JAKDA
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 1:8931 CONFERENCE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4893
Mailing Address - Country:US
Mailing Address - Phone:239-278-0100
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:8931 CONFERENCE DR STE 5
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4893
Practice Address - Country:US
Practice Address - Phone:239-278-0100
Practice Address - Fax:740-383-8517
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2611650Medicaid
OH2611650Medicaid