Provider Demographics
NPI:1326250754
Name:KASHAT, GHAZAWAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAZAWAN
Middle Name:K
Last Name:KASHAT
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 1:35200 DEQUINDRE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4841
Mailing Address - Country:US
Mailing Address - Phone:248-786-8800
Mailing Address - Fax:
Practice Address - Street 1:35200 DEQUINDRE RD STE 600
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4841
Practice Address - Country:US
Practice Address - Phone:248-786-8800
Practice Address - Fax:586-722-7446
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326250754Medicaid
MIGK083271OtherMICHIGAN LICENSE
MI0N40170OtherMEDICARE GROUP NUMBER
MI700E012740OtherBCBS GROUP NUMBER
MIGK083271OtherMICHIGAN LICENSE