Provider Demographics
NPI:1649289877
Name:AHMAD, ATA (MD)
Entity type:Individual
Prefix:
First Name:ATA
Middle Name:
Last Name:AHMAD
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:PO BOX 540088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77254-0088
Mailing Address - Country:US
Mailing Address - Phone:713-850-1190
Mailing Address - Fax:
Practice Address - Street 1:11301 FALLBROOK DR STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4270
Practice Address - Country:US
Practice Address - Phone:281-970-8484
Practice Address - Fax:281-970-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9961208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090EYOtherBCBS
TX31525101Medicaid
TX31525101Medicaid
TX00970LMedicare PIN
TXG39720Medicare UPIN