Provider Demographics
NPI:1760602049
Name:KAMAL, AHSAN (MD PA)
Entity Type:Individual
Prefix:DR
First Name:AHSAN
Middle Name:
Last Name:KAMAL
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21202 OLEAN BLVD STE C1
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6725
Mailing Address - Country:US
Mailing Address - Phone:941-889-7440
Mailing Address - Fax:941-391-6089
Practice Address - Street 1:21202 OLEAN BLVD STE C1
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6725
Practice Address - Country:US
Practice Address - Phone:941-889-7440
Practice Address - Fax:941-391-6089
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02180OtherBCBS
FL6413103OtherCIGNA
FLME97373OtherFL STATE MEDICAL LICENSE
FL005U2OtherBCBS FL
FL005U2OtherBCBS FL
FL02180OtherBCBS