Provider Demographics
NPI:1376587832
Name:AHMAD, KHOSHNOOD (MD)
Entity Type:Individual
Prefix:
First Name:KHOSHNOOD
Middle Name:
Last Name:AHMAD
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 1:11550 LEGACY DRIVE
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-731-7700
Mailing Address - Fax:
Practice Address - Street 1:11550 LEGACY DRIVE
Practice Address - Street 2:SUITE # 420
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-731-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1246208000000X, 2080P0204X, 207PP0204X
NJMA073321208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280591304Medicaid
NJ02068922Medicaid
NM48021784Medicaid
TX280591304Medicaid
NM48021784Medicaid