| Kelly Ahmed M.d., Inc. | |
|
14285 Amargosa Rd Victorville CA 92392-9707 | |
| (760) 955-7095 | |
| (760) 951-1076 |
| Full Name | Kelly Ahmed M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 14285 Amargosa Rd, Victorville, California |
| Authorized Official Name and Position | Kelly J Ahmed (OWNER) |
| Authorized Official Contact | 7609557095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Ahmed M.d., Inc. 14285 Amargosa Rd Victorville CA 92392-9707 Ph: (760) 955-7095 | Kelly Ahmed M.d., Inc. 14285 Amargosa Rd Victorville CA 92392-9707 Ph: (760) 955-7095 |
| NPI Number | 1902277940 |
|---|---|
| Provider Enumeration Date | 10/16/2015 |
| Last Update Date | 10/16/2015 |
| Medicare PECOS PAC ID | 7517277643 |
|---|---|
| Medicare Enrollment ID | O20151102002198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902277940 | NPI | - | NPPES |
| A51407 | Other | CA | MEDICAL LICEANSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A51407 (California) | Primary |
| Provider Name | Kelly J Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659303998 PECOS PAC ID: 2668526831 Enrollment ID: I20090822000020 |
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