Ahmad Tariq Ismail, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME44907 Issued in FL

Practice address

110 East Byrd Ave
Bonifay, FL 32425

Phone

(850) 547-4799

Fax

(850) 547-2305

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 14, 2014.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389657600000",
    "number": "1073680245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EAST BYRD AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "32425",
            "telephone_number": "850-547-4799",
            "fax_number": "850-547-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EAST BYRD AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "32425",
            "telephone_number": "850-547-4799",
            "fax_number": "850-547-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISMAIL",
        "first_name": "AHMAD",
        "middle_name": "TARIQ",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2014-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME44907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "46198",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "043432900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660056500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Michael Dee Kennedy, ARNP

• All providers in Bonifay, FL
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.