Provider Demographics
NPI:1538163860
Name:AHMED, FAHEEM (MD)
Entity type:Individual
Prefix:DR
First Name:FAHEEM
Middle Name:
Last Name:AHMED
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 1:207 CABO DEL SOL CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1719
Mailing Address - Country:US
Mailing Address - Phone:512-545-7842
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4200
Practice Address - Country:US
Practice Address - Phone:512-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4888207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2177420-06Medicaid
TX2177420-07Medicaid
TX2177420-08Medicaid
TX2177420-09Medicaid
OH2683216Medicaid
TX2177420-07Medicaid
OH2683216Medicaid
TX272275YM8AMedicare PIN
TX272275YLP1Medicare PIN
TX272275YKXYMedicare PIN
TX272275YLP2Medicare PIN