MEDICARE: AMRE ASAD GHAZZAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4301513467	MI
2	207RI0011X	Interventional Cardiology Physician	4301513467	MI

General Provider Information

NPI Number	:	1073019956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMRE ASAD GHAZZAL MD

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PAGE AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2462
Country	:	US
Telephone Number	:	517-787-3577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2018
Last Update Date	:	12/09/2025

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