Provider Demographics
NPI:1184741407
Name:ASHRAF MOHAMED, MD, PLC
Entity type:Organization
Organization Name:ASHRAF MOHAMED, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-582-7266
Mailing Address - Street 1:6502 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1701
Mailing Address - Country:US
Mailing Address - Phone:313-582-7266
Mailing Address - Fax:313-582-7026
Practice Address - Street 1:6502 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1701
Practice Address - Country:US
Practice Address - Phone:313-582-7266
Practice Address - Fax:313-582-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50700OtherOMNICARE
MI127665OtherGLHP
MI1308264402OtherBCBSM
MI0N52780Medicare ID - Type Unspecified
MI127665OtherGLHP