Provider Demographics
NPI:1467408344
Name:AHSAN, MUHAMMAD K (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:K
Last Name:AHSAN
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 1:1221 BOWERS ST
Mailing Address - Street 2:UNIT 2653
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7107
Mailing Address - Country:US
Mailing Address - Phone:248-200-7756
Mailing Address - Fax:248-281-3535
Practice Address - Street 1:715 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3237
Practice Address - Country:US
Practice Address - Phone:419-332-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083611A207R00000X
MI4301097463208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2463543Medicaid
000000336858OtherBCBS CLARK COUNTY
000000509617OtherBCBS FAIRFIELD HOS
P00157619OtherMEDICARE RR
P00303491OtherRAIL ROAD MEDICARE
000000336869OtherBCBS
AS4121873Medicare PIN
OHAH4121877Medicare PIN
AH4121872Medicare PIN
OH2463543Medicaid