Provider Demographics
NPI:1528061959
Name:AHUJA, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:AHUJA
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 1:7908 BATTURE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2988
Mailing Address - Country:US
Mailing Address - Phone:318-617-3900
Mailing Address - Fax:
Practice Address - Street 1:201 4TH ST STE 3F
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-685-4149
Practice Address - Fax:318-484-4738
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31052207RG0100X
LA14040R207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1044881Medicaid
LA4F884CS71Medicare PIN
I08807Medicare UPIN