Provider Demographics
NPI:1700882685
Name:AHMAD, FAHEEM (MD)
Entity type:Individual
Prefix:DR
First Name:FAHEEM
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:960 W WOOSTER ST STE 118
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2646
Practice Address - Country:US
Practice Address - Phone:419-354-3185
Practice Address - Fax:419-351-3187
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350809332085R0001X
MI43010703932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2312830Medicaid
OH2312830Medicaid
MI4419011Medicaid
OH920007145OtherRR MEDICARE
MI4449431OtherMI MEDICAID - OH LOCATIONS
MIP00025153OtherRR MEDICARE
OHAH4073401Medicare ID - Type Unspecified
OH920007145OtherRR MEDICARE
MIP00025153OtherRR MEDICARE