Provider Demographics
NPI:1598977738
Name:AHMED KEMMOU, M.D, PLLC
Entity Type:Organization
Organization Name:AHMED KEMMOU, M.D, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMMOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-344-5055
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2303
Mailing Address - Country:US
Mailing Address - Phone:928-344-5055
Mailing Address - Fax:928-344-5655
Practice Address - Street 1:1841 W 25TH ST STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6920
Practice Address - Country:US
Practice Address - Phone:928-344-5055
Practice Address - Fax:928-344-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36282208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ180902Medicaid
AZ1184622342OtherINDIVIDUAL NPI
AZZ114542Medicare PIN
AZ1184622342OtherINDIVIDUAL NPI
AZH43372Medicare UPIN
AZDF8436Medicare PIN
AZZ114541Medicare PIN