Provider Demographics
NPI:1508830779
Name:AHMED, ANSAR H (MBBS)
Entity Type:Individual
Prefix:
First Name:ANSAR
Middle Name:H
Last Name:AHMED
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2220 RIVERSIDE AVE S
Practice Address - Street 2:MAIL STOP 31700A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:612-371-1600
Practice Address - Fax:612-371-1732
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN201372000Medicaid
F16458Medicare UPIN
MN130000804Medicare ID - Type Unspecified