Provider Demographics
NPI:1699748806
Name:ELESBER, AHMAD (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:ELESBER
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 1:601 W MAPLE AVE
Mailing Address - Street 2:STE 703
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-750-2203
Mailing Address - Fax:
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:STE 703
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6699207RC0000X, 207RI0011X
KY40697207RC0000X, 207RI0011X
OH35089719207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184605001Medicaid
AR5AF87C072OtherMEDICARE
OHG65530OtherMEDICARE UPIN
OHPOO449495OtherRR MEDICARE
KYPOO449497OtherRR MEDICARE
OHPOO449495OtherRR MEDICARE
OH4227021Medicare PIN
OHG65530OtherMEDICARE UPIN
KYPOO449497OtherRR MEDICARE