Provider Demographics
NPI:1417481508
Name:AHMED, AASIFUDDIN
Entity Type:Individual
Prefix:
First Name:AASIFUDDIN
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3696
Mailing Address - Country:US
Mailing Address - Phone:414-385-8780
Mailing Address - Fax:414-385-8781
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 550
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3696
Practice Address - Country:US
Practice Address - Phone:414-385-8780
Practice Address - Fax:414-385-8781
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI756552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100175105Medicaid