Provider Demographics
NPI:1063404770
Name:MOHIUDDIN, ASGHAR (MD)
Entity type:Individual
Prefix:
First Name:ASGHAR
Middle Name:
Last Name:MOHIUDDIN
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:PO BOX 77000 DEPT 77220
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:734-462-0340
Mailing Address - Fax:734-462-0344
Practice Address - Street 1:18900 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2669
Practice Address - Country:US
Practice Address - Phone:248-424-8340
Practice Address - Fax:248-424-7209
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066880207R00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP28070099Medicare PIN
MI1346398971OtherGRP NPI
MI20-5485614OtherTAX ID
MIF04018Medicare UPIN
MI5183244-10Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MI0P41360OtherMEDICARE PTAN
MI11-0F33636-0OtherBCBSM GRP PIN