Provider Demographics
NPI:1215425574
Name:ABO-MAHMOOD, AHMED (DPM)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABO-MAHMOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 FOREST PKWY APT 103
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5579
Mailing Address - Country:US
Mailing Address - Phone:903-821-8545
Mailing Address - Fax:
Practice Address - Street 1:1209 FOREST PKWY APT 103
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5579
Practice Address - Country:US
Practice Address - Phone:903-821-8545
Practice Address - Fax:314-932-0877
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022048066213E00000X
OH36.003995213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist