Provider Demographics
NPI:1326200833
Name:AHLAS, ANDREAS GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:GEORGE
Last Name:AHLAS
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 1:2740 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5435
Mailing Address - Country:US
Mailing Address - Phone:559-457-5200
Mailing Address - Fax:559-457-5296
Practice Address - Street 1:2740 S ELM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5435
Practice Address - Country:US
Practice Address - Phone:559-457-5200
Practice Address - Fax:559-457-5296
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124942207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11991FMedicaid
051822Medicare Oscar/Certification
CAFHC11991FMedicaid