Provider Demographics
NPI:1437144961
Name:ALCHOMMALI, AHMAD (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:ALCHOMMALI
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 1:631 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1102
Mailing Address - Country:US
Mailing Address - Phone:712-642-2784
Mailing Address - Fax:712-642-9259
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-449-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-29019207P00000X
NE18735207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1437144961Medicaid
F20622Medicare UPIN
NENA1613015Medicare PIN
NE1437144961Medicaid