Individual
DR. MIRZA W AHMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 W 5TH ST, SUITE 100, LONDON, KY 40741-2112
(606) 864-4040
(606) 864-3500
Mailing address
100 E LIBERY STREET, SUITE 800, LOUISVILLE, KY 40202-1434
(502) 315-1458
(502) 479-1425
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
034761
GA
207RC0000X
Cardiovascular Disease Physician
31393
KY
207RI0011X
Interventional Cardiology Physician
Primary
31393
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000715448AA
—
GA
05
—
000715448AB
—
GA
05
—
000715448AC
—
GA
05
—
000715448AD
—
GA
05
—
000715448AP
—
GA
01
—
319761
WELL CARE (MEDICAID CMO)
GA
01
—
607859800
DEPT OF LABOR #
GA
01
—
708612
BCBS EDI #
GA
05
—
7100366800
—
KY
01
—
P00180131
RAILROAD PROV #
GA
Enumeration date
08/30/2006
Last updated
12/10/2020
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