Provider Demographics
NPI:1124063375
Name:AHMAD, WASEEM (MD)
Entity type:Individual
Prefix:DR
First Name:WASEEM
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:PAVILION 2, STE 3300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-421-0430
Mailing Address - Fax:563-421-0439
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:PAVILION 2, STE 3300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-421-0430
Practice Address - Fax:563-421-0439
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361160052084N0400X
IA376482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116005Medicaid
ILP00320125OtherRR MEDICARE
IL036116005Medicaid