Provider Demographics
NPI:1700848918
Name:MANSOOR AHMED
Entity Type:Organization
Organization Name:MANSOOR AHMED
Other - Org Name:INTEGRATED HEALTH SERVICE MGMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-239-7533
Mailing Address - Street 1:29099 HEALTH CAMPUS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5269
Mailing Address - Country:US
Mailing Address - Phone:440-239-7533
Mailing Address - Fax:
Practice Address - Street 1:29099 HEALTH CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5269
Practice Address - Country:US
Practice Address - Phone:440-274-5035
Practice Address - Fax:440-716-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========00OtherWORKERS COMP
DO9638Medicare PIN
OH9332511Medicare PIN
OH5728190001Medicare NSC
OH9332514Medicare PIN
OH9332512Medicare PIN