Provider Demographics
NPI:1104489608
Name:ASLAM, HIRA (MD)
Entity type:Individual
Prefix:
First Name:HIRA
Middle Name:
Last Name:ASLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20345 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9481
Mailing Address - Country:US
Mailing Address - Phone:734-306-2658
Mailing Address - Fax:
Practice Address - Street 1:24555 HAIG ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3322
Practice Address - Country:US
Practice Address - Phone:313-375-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301506346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYW922560699OtherBLUE CARE NETWORK OF MICHIGAN