Organization
BG ANTAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED FREDDIE AHMAD MD (OWNER)
(440) 315-1489
Entity
Organization
Contact information
Practice address
11716 DETROIT AVE, LAKEWOOD, OH 44107-3002
(440) 315-1489
Mailing address
PO BOX 770800, LAKEWOOD, OH 44107-0037
(440) 315-1489
(440) 363-5875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35124466
OH
Other
Enumeration date
09/22/2016
Last updated
07/21/2022
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