Provider Demographics
NPI:1104978832
Name:AHMAD, MUNIR (MD)
Entity type:Individual
Prefix:DR
First Name:MUNIR
Middle Name:
Last Name:AHMAD
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:PO BOX 351989
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-1989
Mailing Address - Country:US
Mailing Address - Phone:419-535-3214
Mailing Address - Fax:419-535-6794
Practice Address - Street 1:2450 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2841
Practice Address - Country:US
Practice Address - Phone:419-535-3214
Practice Address - Fax:419-535-6794
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036790A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247227Medicaid
OHAH0404592Medicare ID - Type Unspecified
OH0247227Medicaid