Provider Demographics
NPI:1730137118
Name:AHMAD, BURHAAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BURHAAN
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 1:3909 GALEN CT
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6824
Mailing Address - Country:US
Mailing Address - Phone:813-634-5502
Mailing Address - Fax:813-633-2702
Practice Address - Street 1:3909 GALEN CT
Practice Address - Street 2:SUITE #102
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6824
Practice Address - Country:US
Practice Address - Phone:813-634-5502
Practice Address - Fax:813-633-2702
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42029OtherBLUE SHIELD
FL274960200Medicaid
FL42029OtherBC/BS FLORIDA
FL0412712OtherUNITED HEALTHCARE/EVERCARE
1786500OtherCIGNA
FL0412712OtherUNITED HEALTHCARE/EVERCARE
1786500OtherCIGNA
FLU7850ZMedicare PIN