Provider Demographics
NPI:1871931592
Name:ASBAHI, IHSAN (MD)
Entity type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:
Last Name:ASBAHI
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 1:1234 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1433
Mailing Address - Country:US
Mailing Address - Phone:248-319-6630
Mailing Address - Fax:248-319-6631
Practice Address - Street 1:1234 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360
Practice Address - Country:US
Practice Address - Phone:248-319-6630
Practice Address - Fax:248-319-6631
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112558207LP2900X
TXBP10046069390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program