Provider Demographics
NPI:1013608835
Name:ISHAG, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ISHAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 E BELLEVUE ST APT 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4842
Mailing Address - Country:US
Mailing Address - Phone:520-312-8452
Mailing Address - Fax:520-413-1017
Practice Address - Street 1:5240 E BELLEVUE ST APT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4842
Practice Address - Country:US
Practice Address - Phone:520-312-8452
Practice Address - Fax:520-413-1017
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
342000000X
AZ342000000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company