Provider Demographics
NPI:1396941332
Name:ASAD, ISSAM S (MD)
Entity type:Individual
Prefix:DR
First Name:ISSAM
Middle Name:S
Last Name:ASAD
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 1:7188 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-444-9044
Mailing Address - Fax:
Practice Address - Street 1:3435 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320
Practice Address - Country:US
Practice Address - Phone:313-286-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078808208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F317940OtherBCBS OF MICHIGAN
MI700H231390OtherBCBSM GROUP NUMBER
MI383601519OtherTAX ID
MI0N30590Medicare ID - Type Unspecified
MI700H231390OtherBCBSM GROUP NUMBER