Provider Demographics
NPI:1700833191
Name:ASHRAF, ANJUM S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJUM
Middle Name:S
Last Name:ASHRAF
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 1:3400 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0147
Mailing Address - Country:US
Mailing Address - Phone:812-469-6800
Mailing Address - Fax:
Practice Address - Street 1:3400 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0147
Practice Address - Country:US
Practice Address - Phone:812-469-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048619A2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000328027OtherANTHEM PROVIDER #
IN100180890LMedicaid
INP00119093OtherINDIV. RR MEDICARE #
IN200478750Medicaid
IN940280E5Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
IN100180890LMedicaid