Provider Demographics
NPI:1376653634
Name:AHMED, MIRZA W (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:W
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LIBERY STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-315-1458
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:1210 W 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2112
Practice Address - Country:US
Practice Address - Phone:606-864-4040
Practice Address - Fax:606-864-3500
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-12-10
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Provider Licenses
StateLicense IDTaxonomies
KY31393207RC0000X, 207RI0011X
GA034761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000715448AAMedicaid
GA000715448ACMedicaid
GA000715448ADMedicaid
GA000715448APMedicaid
GA319761OtherWELL CARE (MEDICAID CMO)
GA708612OtherBCBS EDI #
KY7100366800Medicaid
GA607859800OtherDEPT OF LABOR #
GAP00180131OtherRAILROAD PROV #
GA000715448ABMedicaid
GA607859800OtherDEPT OF LABOR #
GA000715448ACMedicaid