Provider Demographics
NPI:1003377938
Name:AHMAD, MOHAMMAD USMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:USMAN
Last Name:AHMAD
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 1:69 SANTIAGO AVE
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-5412
Mailing Address - Country:US
Mailing Address - Phone:708-769-8230
Mailing Address - Fax:
Practice Address - Street 1:7900 E UNION AVE STE 1100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2746
Practice Address - Country:US
Practice Address - Phone:866-477-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0066109208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program