Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 61792 | WI |
NPI | 1023431152 |
---|---|
Provider Name | Ahmad Shabir Ahmadzia |
First Address | Quincy, IL 62301-2707 |
Second Address | Quincy, IL 62301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2014 |
Last Update Date | 15/05/2020 |