Provider Demographics
NPI:1356765655
Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Entity type:Organization
Organization Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:SAJEEL
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-945-8717
Mailing Address - Street 1:44105 15TH ST W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4088
Mailing Address - Country:US
Mailing Address - Phone:661-945-8717
Mailing Address - Fax:661-945-1118
Practice Address - Street 1:44105 15TH ST W
Practice Address - Street 2:303
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4089
Practice Address - Country:US
Practice Address - Phone:661-945-8717
Practice Address - Fax:661-945-1118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87434207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty