Provider Demographics
NPI:1427225630
Name:KANDEEL, AHMED F (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:F
Last Name:KANDEEL
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 1:1272 WEST MAIN STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-1880
Mailing Address - Fax:220-564-1881
Practice Address - Street 1:1272 WEST MAIN STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-1880
Practice Address - Fax:220-564-1881
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43806208600000X
CAA116332208600000X
WV23840208600000X
NY245642-1208600000X
OH35.122800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ578807Medicaid
OH3002155Medicaid
OH3002155Medicaid
OHH456470Medicare PIN