Provider Demographics
NPI:1134328180
Name:ALAN T GHASSAN MD PC
Entity Type:Organization
Organization Name:ALAN T GHASSAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GHASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-477-9800
Mailing Address - Street 1:24333 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1976
Mailing Address - Country:US
Mailing Address - Phone:248-477-9800
Mailing Address - Fax:248-477-9801
Practice Address - Street 1:24333 ORCHARD LAKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1976
Practice Address - Country:US
Practice Address - Phone:248-477-9800
Practice Address - Fax:248-477-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG081430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5194640Medicaid
MI1106360522OtherBLUE CARE NETWORK
MI143417OtherCARE CHOICES
MI57513OtherTOTAL HEALTH CARE
MI1106360522OtherBC/BSM
MI0F35639OtherBCBSM
MI57513OtherTOTAL HEALTH CARE
MI5194640Medicaid
MI0P46070Medicare PIN