1396725305 NPI number — MUHAMMAD AHSAN M.D.

Table of content: MUHAMMAD AHSAN M.D. (NPI 1396725305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396725305 NPI number — MUHAMMAD AHSAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHSAN
Provider First Name:
MUHAMMAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396725305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29877 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-1332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-266-2780
Provider Business Mailing Address Fax Number:
734-466-9615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29877 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
348-359-2370
Provider Business Practice Location Address Fax Number:
248-799-2604
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  4301058733 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4339752 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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