Provider Demographics
NPI:1427582444
Name:GHANIM, ASEM (MD)
Entity Type:Individual
Prefix:
First Name:ASEM
Middle Name:
Last Name:GHANIM
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 1:1304 29TH ST S
Mailing Address - Street 2:APT 14
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1951
Mailing Address - Country:US
Mailing Address - Phone:205-240-2535
Mailing Address - Fax:
Practice Address - Street 1:1701 UNIVERSITY BLVD
Practice Address - Street 2:KRACKE BUILDING 417
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1815
Practice Address - Country:US
Practice Address - Phone:205-975-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program