Individual
AHMAD ITANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBCH.
Contact information
Practice address
1100 CENTRAL AVE SE, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87106
(505) 724-6124
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD2024-0310
NM
Other
Enumeration date
05/12/2015
Last updated
07/10/2024
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