Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.124309 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 055401 | CT |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35.124309 | OH |
NPI | 1245525765 |
---|---|
Provider Name | Dr. Isteaq Ahmed |
First Address | Groveport, OH 43125-9119 |
Second Address | Groveport, OH 43125-9119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 17/03/2018 |