Provider Demographics
NPI:1821006594
Name:ABDULLAH, ASHRAF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3911
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3911
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053969OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1103302951OtherBLUE CROSS BLUE SHIELD
MI1103302951OtherBLUE CARE NETWORK
MI200000022163OtherPHP FAMILYCARE
MI1053969OtherMCLAREN HEALTH ADVANTAGE
MI0M21440073OtherMEDICARE ADVANTAGE
MI200000022163OtherPHP
MIP00794956OtherRAILROAD MEDICARE
MI1053969OtherMCLAREN HEALTH PLAN-MEDICAID
MI7355768OtherAETNA
MIF70555Medicare UPIN
MIM21440073Medicare PIN