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Individual

IMTIAZ M AHMAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
14645 HAZEL DELL RD, NOBLESVILLE, IN 46062-7066
(317) 922-2090
(317) 574-1875
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042752
IN
207Q00000X
Family Medicine Physician
01042752A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000208342
ANTHEM
05
100366080
IN
01
Q0087386
SHO
Enumeration date
12/29/2005
Last updated
06/03/2022
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