Provider Demographics
NPI:1396797312
Name:TAHA, AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:TAHA
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 655012
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-5012
Mailing Address - Country:US
Mailing Address - Phone:305-559-5066
Mailing Address - Fax:305-559-5502
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-559-5066
Practice Address - Fax:305-559-5502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83958207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258354201Medicaid
FL258354201Medicaid
FLH32236Medicare UPIN