1861490211 NPI number — DR. SHARIQ AHMAD M.D.

Table of content: DR. SHARIQ AHMAD M.D. (NPI 1861490211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861490211 NPI number — DR. SHARIQ AHMAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMAD
Provider First Name:
SHARIQ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1861490211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3702 S STATE ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SALT LAKE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84115-5096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-288-2634
Provider Business Mailing Address Fax Number:
801-288-1186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2132 N 1700 W
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-7059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-779-3500
Provider Business Practice Location Address Fax Number:
801-779-3508
Provider Enumeration Date:
07/11/2005

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: 207RN0300X , with the licence number:  MO998 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: ME138070 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 12599388-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103780400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173452702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: V1NWY . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1861490211 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103780400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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