Provider Demographics
NPI:1629047816
Name:AHMED, RAHEEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHEEL
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAHEEL
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:2215 NEBRASKA AVE
Mailing Address - Street 2:SUITE 3-B
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4864
Mailing Address - Country:US
Mailing Address - Phone:772-465-8089
Mailing Address - Fax:772-465-8091
Practice Address - Street 1:2215 NEBRASKA AVE
Practice Address - Street 2:SUITE 3-B
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4864
Practice Address - Country:US
Practice Address - Phone:772-465-8089
Practice Address - Fax:772-465-8091
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0071089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256839900Medicaid
FL1629047816OtherCURRENT NPI
FL31418AMedicare PIN