Provider Demographics
NPI:1063208767
Name:AHMAD, HASEEB (MEDICAL STUDENT (MD))
Entity type:Individual
Prefix:
First Name:HASEEB
Middle Name:
Last Name:AHMAD
Suffix:
Gender:
Credentials:MEDICAL STUDENT (MD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1949
Mailing Address - Country:US
Mailing Address - Phone:606-309-0266
Mailing Address - Fax:
Practice Address - Street 1:3300 BEACON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1949
Practice Address - Country:US
Practice Address - Phone:606-309-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program