Provider Demographics
NPI:1316908155
Name:AHMAD, NABIL (MD)
Entity type:Individual
Prefix:DR
First Name:NABIL
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 412024
Mailing Address - Street 2:SUITE NUMBER 120
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-2024
Mailing Address - Country:US
Mailing Address - Phone:314-395-7699
Mailing Address - Fax:314-878-7882
Practice Address - Street 1:12855 N 40 DR STE 275
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8667
Practice Address - Country:US
Practice Address - Phone:314-395-7699
Practice Address - Fax:314-878-7882
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024923208VP0000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5045001Medicare PIN
MOG36676Medicare UPIN