Provider Demographics
NPI:1467864371
Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:SAJEEL
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-945-8717
Mailing Address - Street 1:1535 N CHINA LAKE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1535 N CHINA LAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2667
Practice Address - Country:US
Practice Address - Phone:760-446-4656
Practice Address - Fax:760-446-4656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87434207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty