Provider Demographics
NPI:1811972789
Name:AHMED, ADNAN (MD)
Entity type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:
Last Name:AHMED
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 120836
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0836
Mailing Address - Country:US
Mailing Address - Phone:352-394-1361
Mailing Address - Fax:352-394-1362
Practice Address - Street 1:306 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-7434
Practice Address - Country:US
Practice Address - Phone:352-394-1361
Practice Address - Fax:352-394-1362
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82308207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6548COtherECFMG
FL262050200Medicaid
FL262050200Medicaid
FLF92703Medicare UPIN