Provider Demographics
NPI:1619961026
Name:AHMADI, MEHDI (MD)
Entity Type:Individual
Prefix:MR
First Name:MEHDI
Middle Name:
Last Name:AHMADI
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:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-759-4199
Mailing Address - Fax:
Practice Address - Street 1:204 SOUTH 9TH ST
Practice Address - Street 2:STE A
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-759-4199
Practice Address - Fax:270-767-3632
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29476207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64294762Medicaid
KY1556201Medicare PIN
F54853Medicare UPIN
KY721501Medicare ID - Type Unspecified