Provider Demographics
NPI:1487693156
Name:ABOUHOSSEIN, AHMAD (MD)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:ABOUHOSSEIN
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 1:3170 KETTERING BLVD
Mailing Address - Street 2:BUILDING B 3RD FLOOR
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-832-8400
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:9000 N MAIN ST STE 333
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1185
Practice Address - Country:US
Practice Address - Phone:937-832-8400
Practice Address - Fax:937-245-6308
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036788208800000X
OH35036788A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314805Medicaid
OH0314805Medicaid
A14814Medicare UPIN
OHAB0404713Medicare PIN
OHA14814Medicare UPIN
A14814Medicare UPIN