Provider Demographics
NPI:1639143548
Name:AHMAD, MAQSOOD (MD)
Entity Type:Individual
Prefix:
First Name:MAQSOOD
Middle Name:
Last Name:AHMAD
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 1:5434 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2298
Mailing Address - Country:US
Mailing Address - Phone:414-442-5400
Mailing Address - Fax:414-442-5468
Practice Address - Street 1:5434 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2298
Practice Address - Country:US
Practice Address - Phone:414-442-5400
Practice Address - Fax:414-442-5468
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33146174400000X
WI33146-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31980200Medicaid
WIBA3197820OtherDAE
WI33146-020OtherSTATE LICENSE
WI33146-020OtherSTATE LICENSE
WI000073029Medicare PIN