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 1:19850 M GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:GIBRALTAR
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8701
Mailing Address - Country:US
Mailing Address - Phone:734-301-3125
Mailing Address - Fax:734-301-3325
Practice Address - Street 1:19850 M GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:GIBRALTAR
Practice Address - State:MI
Practice Address - Zip Code:48173-8701
Practice Address - Country:US
Practice Address - Phone:734-301-3125
Practice Address - Fax:734-301-3325
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067646207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0823404OtherBLUECARE NETWORK
MI0Q26305007OtherBLUECROSSBLUESHIELD OF MI
MI4748038Medicaid
MIRR PTAN P00280231Medicare PIN
MI0Q26305007Medicare PIN
MI0823404OtherBLUECARE NETWORK