Provider Demographics
NPI:1730129222
Name:AHMED, SULTAN S (MD)
Entity type:Individual
Prefix:
First Name:SULTAN
Middle Name:S
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 1:6151 MIRAMAR PKWY
Mailing Address - Street 2:SUTIE 104
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3970
Mailing Address - Country:US
Mailing Address - Phone:954-965-6001
Mailing Address - Fax:954-965-6009
Practice Address - Street 1:6151 MIRAMAR PKWY
Practice Address - Street 2:SUTIE 104
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3970
Practice Address - Country:US
Practice Address - Phone:954-965-6001
Practice Address - Fax:954-965-6009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272692100Medicaid
32644OtherBCBS
I02799Medicare UPIN
FLE7722XMedicare PIN