Provider Demographics
NPI:1104989730
Name:YOSHIDA, ATSUSHI (MD)
Entity type:Individual
Prefix:
First Name:ATSUSHI
Middle Name:
Last Name:YOSHIDA
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:2799 WEST GRAND BOULEVARD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-7178
Mailing Address - Fax:313-916-4353
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2799 WEST GRAND BOULEVARD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-7178
Practice Address - Fax:313-916-4353
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076128204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI424113810Medicaid
AY076128OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262310OtherBLUE CROSS-BLUE CROSS
AY076128OtherCHAMPUS-CHAMPUS