Provider Demographics
NPI:1740264696
Name:AHMAD, SAHAR (MD)
Entity type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GRANT ST
Mailing Address - Street 2:SUITE S250
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3483
Mailing Address - Country:US
Mailing Address - Phone:920-734-9600
Mailing Address - Fax:920-734-4773
Practice Address - Street 1:820 E GRANT ST
Practice Address - Street 2:SUITE S250
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3483
Practice Address - Country:US
Practice Address - Phone:920-734-9600
Practice Address - Fax:920-734-4773
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH25619Medicare UPIN