Individual
SIRAJ K AHMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 E CENTER ST, MANTECA, CA 95336-4720
(209) 665-7054
(209) 647-4805
Mailing address
1112 NORTH MAIN STREET, PMB 311, MANTECA, CA 95336-3208
(209) 665-7054
(209) 647-4805
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01041335A
IN
207RP1001X
Pulmonary Disease Physician
Primary
01041335A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265513121
—
CA
01
—
CA238933
MEDICARE
—
Enumeration date
10/18/2006
Last updated
10/03/2019
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