Provider Demographics
NPI:1184620924
Name:AHMADI, AHMAD H (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:H
Last Name:AHMADI
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 1:1112 SOLDIERS FIELD DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4001
Mailing Address - Country:US
Mailing Address - Phone:281-265-2639
Mailing Address - Fax:281-313-6665
Practice Address - Street 1:1112 SOLDIERS FIELD DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4001
Practice Address - Country:US
Practice Address - Phone:281-265-2639
Practice Address - Fax:281-313-6665
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-06-15
Deactivation Date:2006-04-03
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TXL1510208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0054HXOtherBLUE CROSS BLUE SHIELD
TN1576183-01Medicaid
TN1576183-01Medicaid
TX00320FMedicare ID - Type Unspecified