Provider Demographics
NPI:1598776270
Name:AHMED, MOHAMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:S
Last Name:AHMED
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 1:1648 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7906
Mailing Address - Country:US
Mailing Address - Phone:928-758-4114
Mailing Address - Fax:928-758-4650
Practice Address - Street 1:1648 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7906
Practice Address - Country:US
Practice Address - Phone:928-758-4114
Practice Address - Fax:928-758-4650
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28306207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249187Medicaid
AZ249187Medicaid
AZZ181228Medicare PIN
NVV103399Medicare PIN