Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 102950 | MN |
N | 111NI0900X | Internist | 102950 | MN |
N | 207RC0000X | Internist - Cardiovascular Disease | 052275 | CT |
N | 207RC0000X | Internist - Cardiovascular Disease | MT198590 | PA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 036-140036 | IL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 052275 | CT |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 65353-20 | WI |
NPI | 1053536219 |
---|---|
Provider Name | Imdad Ahmed |
First Address | Janesville, WI 53548-2940 |
Second Address | Janesville, WI 53548-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 19/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053536219 | (05) | WI |