Provider Demographics
NPI:1235578485
Name:MAHMOUD, AMMAR (MD)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:MAHMOUD
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 1:1716 LAWRENCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9108
Mailing Address - Country:US
Mailing Address - Phone:920-276-8600
Mailing Address - Fax:920-632-6806
Practice Address - Street 1:1540 LYON DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-5069
Practice Address - Country:US
Practice Address - Phone:920-276-8600
Practice Address - Fax:920-632-6806
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME21879207L00000X
IL125063751207L00000X
MEMD21879207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology