Provider Demographics
NPI:1851376305
Name:AHMED, IFTIKHAR (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
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 1:14019 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4459
Mailing Address - Country:US
Mailing Address - Phone:480-668-3737
Mailing Address - Fax:
Practice Address - Street 1:14019 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4459
Practice Address - Country:US
Practice Address - Phone:480-668-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36212207ND0900X
AZ25050207ND0900X, 207ZD0900X
UT176536-1205207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN069817200Medicaid
MN069817200Medicaid
220000401Medicare ID - Type Unspecified
220009999Medicare ID - Type UnspecifiedRAILROAD
F50536Medicare UPIN