Provider Demographics
NPI:1477032647
Name:MIRI, AHMAD RAJIH
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:RAJIH
Last Name:MIRI
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 1:982161 NEBRASKA MEDICAL CENTER PEDIATRICS DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-2161
Mailing Address - Country:US
Mailing Address - Phone:402-559-2412
Mailing Address - Fax:
Practice Address - Street 1:982161 NEBRASKA MEDICAL CENTER PEDIATRICS DEPARTMENT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2161
Practice Address - Country:US
Practice Address - Phone:402-559-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE83822080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology