Provider Demographics
NPI:1447459912
Name:AHMADI, HODA (MD)
Entity type:Individual
Prefix:
First Name:HODA
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4375
Mailing Address - Country:US
Mailing Address - Phone:262-723-4600
Mailing Address - Fax:262-723-4710
Practice Address - Street 1:1311 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4375
Practice Address - Country:US
Practice Address - Phone:262-723-4600
Practice Address - Fax:262-723-4710
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56317207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447459912Medicaid