Provider Demographics
NPI:1013942366
Name:AHMED MD, SYED WASEEMUDDIN
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:WASEEMUDDIN
Last Name:AHMED MD
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:PO BOX 7309
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33883-7309
Mailing Address - Country:US
Mailing Address - Phone:863-293-9500
Mailing Address - Fax:863-293-9511
Practice Address - Street 1:675 AVENUE L SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4219
Practice Address - Country:US
Practice Address - Phone:863-293-9500
Practice Address - Fax:863-293-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068923207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593688407OtherAETNA,BCBS,CIGNA
FL250248800Medicaid
FLG25389Medicare UPIN
FL593688407OtherAETNA,BCBS,CIGNA