Provider Demographics
NPI:1104961127
Name:AHMED, GHAZALA IJAZ (MD)
Entity type:Individual
Prefix:DR
First Name:GHAZALA
Middle Name:IJAZ
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GHAZALA
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8980 KILGORE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5414
Mailing Address - Country:US
Mailing Address - Phone:407-876-7631
Mailing Address - Fax:407-876-8235
Practice Address - Street 1:8980 KILGORE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5414
Practice Address - Country:US
Practice Address - Phone:407-876-7631
Practice Address - Fax:407-876-8235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0059456OtherMEDICAL LICENCE
FLBA 4175584OtherDEA #
FLE-94935Medicare UPIN