Provider Demographics
NPI:1861490211
Name:AHMAD, SHARIQ (MD)
Entity type:Individual
Prefix:DR
First Name:SHARIQ
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 S STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5096
Mailing Address - Country:US
Mailing Address - Phone:801-288-2634
Mailing Address - Fax:801-288-1186
Practice Address - Street 1:2132 N 1700 W
Practice Address - Street 2:STE 110
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7059
Practice Address - Country:US
Practice Address - Phone:801-779-3500
Practice Address - Fax:801-779-3508
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMO998207RN0300X
FLME138070207RN0300X
UT12599388-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103780400Medicaid
TX173452702Medicaid
FLV1NWYOtherBCBS
UT1861490211Medicaid