AHMET DERVISH MD NPI 1104854462

NPI Information

  • NPI: 1104854462
  • Provider Name: AHMET DERVISH, MD
  • Classification: Pain Medicine - 208VP0014X
  • Specialization: Interventional Pain Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2845 GREENBRIER RD STE 340
    GREEN BAY, WI
    ZIP 54311
  • Phone: (920) 288-8380

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NPI Details

Ahmet Dervish, MD is an interventional pain medicine pain medicine in Green Bay, WI. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. Ahmet Dervish, MD NPI is 1104854462. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2845 GREENBRIER RD STE 340
GREEN BAY, WI
ZIP 54311-519
Phone: (920) 288-8380
Fax: (920) 288-8385

The NPI 1104854462 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/28/2006 and was last updated on 8/29/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208VP0014XPain MedicineInterventional Pain Medicine33794WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
132021400MEDICAIDWISCONSIN
2050080452OTHERWISCONSINRAILROAD
3F87383MEDICARE UPINWISCONSIN
4013407650MEDICARE ID-TYPE UNSPECIFIEDWISCONSIN
5104365449MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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