Provider Demographics
NPI:1861568800
Name:AHMED, KHAIRAT UDDIN (MD)
Entity type:Individual
Prefix:
First Name:KHAIRAT
Middle Name:UDDIN
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 1:651 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1965
Mailing Address - Country:US
Mailing Address - Phone:937-328-5277
Mailing Address - Fax:937-328-5276
Practice Address - Street 1:1 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-2201
Practice Address - Country:US
Practice Address - Phone:937-328-5277
Practice Address - Fax:937-328-5276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-7140A302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2007063Medicaid
OHA74898Medicare UPIN
OHK9223402Medicare ID - Type Unspecified