Amtul R Ahmad MD SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

40006020 Issued in WI

Legal business name

AMTUL R AHMAD MD SC

Doing business as

Amtul R Ahmad MD SC

Practice address

3601 30TH Ave
Suite #101
Kenosha, WI 53144-1695

Phone

(262) 564-0611

Fax

(262) 564-0601

NPI assigned

Sep 29, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amtul Rehman Ahmad, MD

Title

President/Owner

Phone

(262) 564-0611

Specialties & licenses 1

Addresses

Other names 1

• Amtul R Ahmad MD SC Doing business as

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1467544346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 30TH AVE",
            "address_2": "SUITE #101",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441695",
            "telephone_number": "262-564-0611",
            "fax_number": "262-564-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 30TH AVE",
            "address_2": "SUITE #101",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441695",
            "telephone_number": "262-564-0611",
            "fax_number": "262-564-0601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMTUL R AHMAD MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "AMTUL",
        "authorized_official_middle_name": "REHMAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "262-564-0611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "40006020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amtul R Ahmad MD SC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.