Provider Demographics
NPI:1063552396
Name:AHMED, IFTIKHAR (MD)
Entity type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:
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 1:3401 CAPITAL CIR NE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-3711
Mailing Address - Country:US
Mailing Address - Phone:850-386-2266
Mailing Address - Fax:850-893-0019
Practice Address - Street 1:3401 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3711
Practice Address - Country:US
Practice Address - Phone:850-386-2266
Practice Address - Fax:850-893-0019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074853207Q00000X
FLME74853208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254033900Medicaid
FL44588BMedicare ID - Type Unspecified
FL44588XMedicare PIN
FL254033900Medicaid