Provider Demographics
NPI:1386636447
Name:AHMED, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-576-8102
Mailing Address - Fax:314-576-8122
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:SUITE 506
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-576-8102
Practice Address - Fax:314-576-8122
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO100874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00249011OtherRAILROAD MEDICARE
MO918403444Medicare PIN
MOF82174Medicare UPIN
MO918404705Medicare PIN