Provider Demographics
NPI:1609045913
Name:ABBASI, AISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:
Last Name:ABBASI
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 1:5720 BLOOMFIELD GLENS RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2501
Mailing Address - Country:US
Mailing Address - Phone:248-851-6339
Mailing Address - Fax:
Practice Address - Street 1:5720 BLOOMFIELD GLENS RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2501
Practice Address - Country:US
Practice Address - Phone:248-851-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010528432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260-63-5602-2OtherBLUE CROSS PIN
MIF23796Medicare UPIN
MI260-63-5602-2OtherBLUE CROSS PIN