Provider Demographics
NPI:1760450811
Name:GHASSAN, ALAN TAHSIN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:TAHSIN
Last Name:GHASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:TAHSIN
Other - Last Name:GHASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24333 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1976
Mailing Address - Country:US
Mailing Address - Phone:248-476-0660
Mailing Address - Fax:248-477-1780
Practice Address - Street 1:24333 ORCHARD LAKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1976
Practice Address - Country:US
Practice Address - Phone:248-476-0660
Practice Address - Fax:248-476-1780
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33502OtherBCBSM
MI4876520Medicaid
MI5194640Medicaid
MI0636052OtherBC/BS
MI0636052OtherBC/BS
MI4876520Medicaid