Amtul R Ahmad MD SC
Organization Active NPI Pediatrics Physician · Kenosha, WI
NPI 1467544346 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1467544346
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 40006020 (WI)
- Legal business name
- 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Amtul Rehman Ahmad, MD
- Title
- President/Owner
- Phone
- (262) 564-0611
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 40006020 | WI | Yes |
Addresses
Primary practice location
3601 30TH Ave
Suite #101
Kenosha, WI 53144-1695
Mailing address
3601 30TH Ave
Suite #101
Kenosha, WI 53144-1695
Phone (262) 564-0611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32466300 | Medicaid | WI |
Other names
- Amtul R Ahmad MD SC
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All providers in Kenosha, WI · Pediatrics Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.