1912984782 NPI number — DR MUNIR AHMAD MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912984782 NPI number — DR MUNIR AHMAD MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR MUNIR AHMAD MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912984782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44000 GARFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-412-4262
Provider Business Mailing Address Fax Number:
586-412-4102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 FAIR LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFFIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-448-3690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AHMAD
Authorized Official First Name:
MUNIR
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
419-455-8101

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0118545 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD1028 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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