1598750929 NPI number — AHMAD M FAHMY OD

Table of content: AHMAD M FAHMY OD (NPI 1598750929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598750929 NPI number — AHMAD M FAHMY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAHMY
Provider First Name:
AHMAD
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598750929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9801 DUPONT AVE S
Provider Second Line Business Mailing Address:
SUITE 425
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-567-6092
Provider Business Mailing Address Fax Number:
952-567-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-813-3600
Provider Business Practice Location Address Fax Number:
612-813-3601
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  2842 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00147507 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 065860000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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