Provider Demographics
NPI:1447220371
Name:ISHAQUE, ASIF (MD)
Entity Type:Individual
Prefix:MR
First Name:ASIF
Middle Name:
Last Name:ISHAQUE
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 1:9244 LAPEER ROAD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-653-2111
Mailing Address - Fax:810-653-8506
Practice Address - Street 1:9244 LAPEER ROAD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-653-2111
Practice Address - Fax:810-653-8506
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
098S094OtherHEALTH PLUS
1102S10260OtherBLUE CARE NETWORK
MI4S20448Medicaid
MIAI062301OtherBCBSM BLUE CROSS
MI4S20448Medicaid
MI0N82050Medicare ID - Type Unspecified