Ahmad A Maqboul, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6626-20 Issued in WI

Practice address

1160 Kepler Dr
Green Bay, WI 54311-8321

Phone

(920) 288-5400

NPI assigned

Sep 22, 2013

Last updated

Apr 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• VHS Physicians of Michigan

  dba DMC Medical Group

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1073827101
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1306272372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118321",
            "telephone_number": "920-288-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118321",
            "telephone_number": "920-288-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "97 Monroe St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482262855",
            "country_code": "US",
            "telephone_number": "313-965-3365",
            "fax_number": "313-965-3622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAQBOUL",
        "first_name": "AHMAD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-22",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301104344",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "6626-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Koti R Mannem, MD
• Manor Care of Green Bay Wi (East) LLC (ManorCare Health Services-East)
• Manor Care of Green Bay Wi (West) LLC (ManorCare Health Services-West)
• Mitchell W Manthey, MD
• Derek Manz, OT
• Ramana R Marada, MD
• S. Patrick Maraka, DDS
• Anthony Joseph Marchlewski, MD
• Amber Marciniak
• Timothy Joseph Marciniak, H.I.S.

• Family Medicine Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.