Provider Demographics
NPI:1710083506
Name:AHAMAD, ANESA W (MD)
Entity Type:Individual
Prefix:
First Name:ANESA
Middle Name:W
Last Name:AHAMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:21355 E DIXIE HWY STE 111
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-692-1100
Practice Address - Fax:305-692-1111
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL85842085R0001X
FLME894382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1052055OtherCIGNA
FL346218OtherAVMED
FLP00921457OtherRAILROAD MEDICARE
FL14C0HOtherBCBS FL
TX158343701Medicaid
FL7490640OtherAETNA THRU KEYS PHA
FL003252000Medicaid
FL789645OtherWELLCARE
FL003252000Medicaid
FL14C0HOtherBCBS FL
FLER850ZMedicare PIN