Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01054343A | IN |
NPI | 1023022118 |
---|---|
Provider Name | Maqbool A Ahmed |
First Address | Evansville, IN 47737-3868 |
Second Address | Evansville, IN 47713-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200335110 | (05) | IN |
H40335 | (02) | IN |