Provider Demographics
NPI:1396881017
Name:AHMED, IMRAN (MD)
Entity type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:AHMED
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 1:555 W STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5119
Mailing Address - Country:US
Mailing Address - Phone:321-842-2994
Mailing Address - Fax:321-842-1852
Practice Address - Street 1:555 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5119
Practice Address - Country:US
Practice Address - Phone:321-842-2994
Practice Address - Fax:321-842-1852
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396881017OtherNPI NUMBER
MO2018033142OtherMO LICENCE NUMBER