Provider Demographics
NPI:1184604357
Name:AMJAD, RAMAK R (MD)
Entity type:Individual
Prefix:
First Name:RAMAK
Middle Name:R
Last Name:AMJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5886
Mailing Address - Country:US
Mailing Address - Phone:573-268-0529
Mailing Address - Fax:
Practice Address - Street 1:1404 DUKE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5886
Practice Address - Country:US
Practice Address - Phone:573-268-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL32282080N0001X
MO109601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147742401Medicaid
MO209025907Medicaid
TX147742403Medicaid
TX155230901Medicaid
TX147742402Medicaid
MOH87056Medicare UPIN
TX155230901Medicaid
MO903455236Medicare PIN
TX147742401Medicaid