Provider Demographics
NPI:1982717195
Name:ANSARI, FARHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:
Last Name:ANSARI
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 1:800 COOPER AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5394
Mailing Address - Country:US
Mailing Address - Phone:989-753-9200
Mailing Address - Fax:989-753-2198
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5394
Practice Address - Country:US
Practice Address - Phone:989-753-9200
Practice Address - Fax:989-753-2198
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFA056592207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI290G31026OtherBCBS OF MI
MI4229151Medicaid
MI0G31026OtherBLUE CARE NETWORK OF MI
MI0982484OtherHEALTH PLUS
MI0M53370003Medicare PIN
MI4229151Medicaid