Provider Demographics
NPI:1467448134
Name:AHSAN, LUBNA (MD)
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:AHSAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 N ELMS RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9426
Mailing Address - Country:US
Mailing Address - Phone:810-487-3500
Mailing Address - Fax:810-487-3530
Practice Address - Street 1:6940 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9760
Practice Address - Country:US
Practice Address - Phone:989-746-0933
Practice Address - Fax:989-746-5070
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N56750Medicare ID - Type Unspecified
MIG53597Medicare UPIN