Provider Demographics
NPI:1548346661
Name:MIAN, AHMAD
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:MIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BUSINESS PARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6322
Mailing Address - Country:US
Mailing Address - Phone:315-735-3541
Mailing Address - Fax:
Practice Address - Street 1:125 BUSINESS PARK DR STE 150
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6322
Practice Address - Country:US
Practice Address - Phone:315-735-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245768207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02914212Medicaid