Provider Demographics
NPI:1902807381
Name:AHMAD, AFTAB (MD)
Entity Type:Individual
Prefix:
First Name:AFTAB
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 1:15511 N FLORIDA AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1220
Mailing Address - Country:US
Mailing Address - Phone:813-963-3124
Mailing Address - Fax:
Practice Address - Street 1:15511 N FLORIDA AVE STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1220
Practice Address - Country:US
Practice Address - Phone:813-963-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072089207R00000X
FLME119091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301072089OtherCONTROLLED SUBSTANCE
BA5893537OtherFEDERAL DEA
G81615Medicare UPIN
MI0799500Medicare PIN