Provider Demographics
NPI:1588824098
Name:AHMAD, USMA SHAHEEN (MD MBBS)
Entity Type:Individual
Prefix:DR
First Name:USMA
Middle Name:SHAHEEN
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 E UNIVERSITY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8048
Mailing Address - Country:US
Mailing Address - Phone:480-398-1220
Mailing Address - Fax:480-398-1230
Practice Address - Street 1:1134 E UNIVERSITY DR STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8048
Practice Address - Country:US
Practice Address - Phone:480-398-1220
Practice Address - Fax:480-398-1230
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233424207R00000X
AZ44841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624740Medicaid
AZ624740Medicaid