Provider Demographics
NPI:1417985516
Name:DASS, ASHVANI BAWA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHVANI
Middle Name:BAWA
Last Name:DASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:39650 ORCHARD HILL PL
Mailing Address - Street 2:200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:2040 AURELIUS RD STE 20
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1367
Practice Address - Country:US
Practice Address - Phone:517-699-3937
Practice Address - Fax:517-699-4199
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056002207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87556Medicare UPIN
MI0M21980014Medicare PIN
MI1417985516Medicaid
MI0Q26082028Medicare PIN
MI0M21980014Medicare PIN
MI3071946Medicaid
MI4879853Medicaid
MI0Q26082028Medicare PIN