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 1:4100 BEECHER RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3661
Mailing Address - Country:US
Mailing Address - Phone:810-342-3813
Mailing Address - Fax:103-423-7848
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3257
Practice Address - Country:US
Practice Address - Phone:989-772-6811
Practice Address - Fax:989-772-6795
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-04-15
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
MI0N24000012OtherMEDICARE
OH2312830Medicaid
MI4419011Medicaid
OH920007145OtherRR MEDICARE
MI4449431OtherMI MEDICAID - OH LOCATIONS
MIP00025153OtherRR MEDICARE
OHAH4073401Medicare ID - Type Unspecified
OH920007145OtherRR MEDICARE
MIP00025153OtherRR MEDICARE