Provider Demographics
NPI:1871602896
Name:AHMAD, FUAD SHIHAB (APNP)
Entity type:Individual
Prefix:MR
First Name:FUAD
Middle Name:SHIHAB
Last Name:AHMAD
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1721
Mailing Address - Country:US
Mailing Address - Phone:414-962-6016
Mailing Address - Fax:
Practice Address - Street 1:6430 GREENBAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2948
Practice Address - Country:US
Practice Address - Phone:262-925-0535
Practice Address - Fax:262-925-0538
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2898363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care