Provider Demographics
NPI:1891755021
Name:AHMED, MAHTAB UDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:UDDIN
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 E RUSHOLME ST STE 301
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2400
Mailing Address - Country:US
Mailing Address - Phone:563-421-8361
Mailing Address - Fax:563-421-8369
Practice Address - Street 1:1230 E RUSHOLME ST STE 301
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2400
Practice Address - Country:US
Practice Address - Phone:563-421-8361
Practice Address - Fax:563-421-8369
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-48052207QB0002X
OH35067724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0177795Medicaid
OH0177795Medicaid
OHG12219Medicare UPIN