MEDICARE: LUBNA AHSAN 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	207R00000X	Internal Medicine Physician	4301064203	MI

General Provider Information

NPI Number	:	1467448134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBNA AHSAN MD

Provider Business Mailing Address
First Line	:	2487 N ELMS RD
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-9426
Country	:	US
Telephone Number	:	810-487-3500
Fax Number	:	810-487-3530

Provider Business Practice Location Address
First Line	:	6940 DIXIE HWY
Second Line	:
City	:	BRIDGEPORT
State	:	MI
Zip	:	48722-9760
Country	:	US
Telephone Number	:	989-746-0933
Fax Number	:	989-746-5070

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	09/23/2022

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