Provider Demographics
NPI:1588609267
Name:ASFOUR, ABEDELRAHIM (MD)
Entity type:Individual
Prefix:
First Name:ABEDELRAHIM
Middle Name:
Last Name:ASFOUR
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:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 850
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4218
Practice Address - Country:US
Practice Address - Phone:602-406-1150
Practice Address - Fax:602-406-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72628207RI0011X, 207RI0011X
MI4301067646207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0823404OtherBLUECARE NETWORK
MI4748038Medicaid
MI0Q26305007OtherBLUECROSSBLUESHIELD OF MI
MIRR PTAN P00280231Medicare PIN
MI0Q26305007Medicare PIN
MI0823404OtherBLUECARE NETWORK