Provider Demographics
NPI:1760407001
Name:AHMED, GIASUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:GIASUDDIN
Middle Name:
Last Name:AHMED
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 1:2391 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4989
Mailing Address - Country:US
Mailing Address - Phone:269-683-3898
Mailing Address - Fax:
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051797A207P00000X
MI4301076791207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200296500Medicaid
MI1760407001Medicaid
178650FFMedicare ID - Type Unspecified
INH26469Medicare UPIN
142520OOMedicare ID - Type Unspecified
IN295910MMMMMedicare ID - Type Unspecified
MI1760407001Medicaid
IN200296500Medicaid
IN193810ZMedicare PIN