Provider Demographics
NPI:1346988037
Name:AHMED, IJAZ (MD)
Entity Type:Individual
Prefix:
First Name:IJAZ
Middle Name:
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 1:9200 N CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2463
Mailing Address - Country:US
Mailing Address - Phone:602-943-9494
Mailing Address - Fax:602-944-3898
Practice Address - Street 1:9200 N CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2463
Practice Address - Country:US
Practice Address - Phone:602-943-9494
Practice Address - Fax:602-944-3898
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR79179390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program