Provider Demographics
NPI:1760537559
Name:RAHEEL AHMED MD PA
Entity Type:Organization
Organization Name:RAHEEL AHMED MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-465-8089
Mailing Address - Street 1:782 SW MARSH HARBOR BAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3439
Mailing Address - Country:US
Mailing Address - Phone:772-465-8089
Mailing Address - Fax:772-465-8091
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-8089
Practice Address - Fax:772-465-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-01-13
Deactivation Date:2008-08-01
Deactivation Code:
Reactivation Date:2010-05-17
Provider Licenses
StateLicense IDTaxonomies
FLME71089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250869900Medicaid
FL31418OtherBCBS
FL31418ZMedicare PIN
FL250869900Medicaid