Basic Information
| Provider Information | |||||||||
| NPI: | 1174521009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | IMTIAZ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS DEPT. | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 16420 HEALTHPARK COMMONS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339089621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394376670 | ||||||||
| FaxNumber: | 2394378871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME76783 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | ME76783 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2705354-00 | 05 | FL | MEDICAID | P930339 | 01 | FL | OPTIMUM | OTHER | 42972 | 01 | FL | BCBS OF FL | OTHER | 264114 | 01 | FL | WELLCARE THROUGH LEE PHO | OTHER | 264114 | 01 | FL | MEDICARE (WELLCARE) AND MEDICAID (STAYWELL) | OTHER | 2066082 | 01 | FL | CIGNA | OTHER | 307272 | 01 | FL | AVMED | OTHER | P01266913 | 01 | FL | RAILROAD MCR | OTHER | 7809584 | 01 | FL | AETNA | OTHER | ASLC2013 | 01 | FL | FREEDOM HEALTH | OTHER |