Provider Demographics
NPI:1598248494
Name:ASMAR, IHSAN
Entity Type:Individual
Prefix:
First Name:IHSAN
Middle Name:
Last Name:ASMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 LOVETT CT
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2769
Mailing Address - Country:US
Mailing Address - Phone:734-589-8770
Mailing Address - Fax:
Practice Address - Street 1:4004 LOVETT CT
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2769
Practice Address - Country:US
Practice Address - Phone:734-589-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820354772172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI463Q6OtherHOME
MI454508451OtherSTATE