Provider Demographics
NPI:1841413440
Name:MUSADDEQUE AHMAD,MD,PC
Entity Type:Organization
Organization Name:MUSADDEQUE AHMAD,MD,PC
Other - Org Name:HEARTLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSADDEQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-438-9264
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0069
Mailing Address - Country:US
Mailing Address - Phone:573-438-9264
Mailing Address - Fax:573-438-5195
Practice Address - Street 1:10048 SETTLE MILL RD
Practice Address - Street 2:
Practice Address - City:CADET
Practice Address - State:MO
Practice Address - Zip Code:63630-9288
Practice Address - Country:US
Practice Address - Phone:573-438-9264
Practice Address - Fax:573-438-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107382261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263881Medicare Oscar/Certification