Provider Demographics
NPI:1295787687
Name:ASBAHI, MOWAFAK (MD)
Entity type:Individual
Prefix:
First Name:MOWAFAK
Middle Name:
Last Name:ASBAHI
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 1:43261 WATERWHEEL COURT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-349-7122
Mailing Address - Fax:
Practice Address - Street 1:18320 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3230
Practice Address - Country:US
Practice Address - Phone:248-476-6100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMA033455207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0826296OtherBLUE CARE NETWORK
MI0826296OtherBLUE CROSS BLUE SHIELD
0826296OtherBLUE CARE NETWORK
MIB44672Medicare UPIN