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Organization

SIRAJ K AHMED MD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JACOB WOLF (CREDENTIALING DEPARTMENT)
(209) 956-9166
Entity
Organization

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) 239-9594

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
C138466
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1265513121
CA
Enumeration date
01/26/2017
Last updated
10/03/2019
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