Provider Demographics
NPI:1053568667
Name:BOLKHIR, AHMED A (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:A
Last Name:BOLKHIR
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 1:500 WALTER ST NE STE 401
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2563
Mailing Address - Country:US
Mailing Address - Phone:505-727-7833
Mailing Address - Fax:505-727-9590
Practice Address - Street 1:500 WALTER ST NE STE 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2563
Practice Address - Country:US
Practice Address - Phone:505-727-7833
Practice Address - Fax:505-727-9590
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070297207R00000X
AZ67862207RG0100X
OK32006207RG0100X
WI53026207RG0100X
IL036122476208M00000X
NMMD2021-1113207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07576579Medicaid
IN201040770Medicaid
INM400059551Medicare PIN