Provider Demographics
NPI:1881673499
Name:AHMED, ASIF J (MD)
Entity Type:Individual
Prefix:
First Name:ASIF
Middle Name:J
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 1:1634 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4860
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-762-9747
Practice Address - Street 1:1634 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4860
Practice Address - Country:US
Practice Address - Phone:309-762-9711
Practice Address - Fax:309-762-9747
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-34947207L00000X
IL036076702207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97825Medicare UPIN