Provider Demographics
NPI:1922071158
Name:AHMED, IMTIAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:IMTIAZ
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 1:903 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4941
Mailing Address - Country:US
Mailing Address - Phone:407-846-4000
Mailing Address - Fax:407-846-4808
Practice Address - Street 1:903 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4941
Practice Address - Country:US
Practice Address - Phone:407-846-4000
Practice Address - Fax:407-846-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058868174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268025400Medicaid
FL18708Medicare ID - Type Unspecified
FL268025400Medicaid