Provider Demographics
NPI:1316998693
Name:GHANI, NESRENE A (MD)
Entity type:Individual
Prefix:
First Name:NESRENE
Middle Name:A
Last Name:GHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5245 SCHEAFER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-624-0000
Mailing Address - Fax:313-624-0063
Practice Address - Street 1:5245 SCHAEFER RD
Practice Address - Street 2:SUITE A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3257
Practice Address - Country:US
Practice Address - Phone:313-624-0000
Practice Address - Fax:313-624-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2022-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301055729OtherLICENSE
F67698Medicare UPIN
MIP02460002Medicare PIN