Healthcare Provider Details

I. General information

NPI: 1467448134
Provider Name (Legal Business Name): LUBNA AHSAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 DIXIE HWY
BRIDGEPORT MI
48722-9760
US

IV. Provider business mailing address

2487 N ELMS RD
FLUSHING MI
48433-9426
US

V. Phone/Fax

Practice location:
  • Phone: 989-746-0933
  • Fax: 989-746-5070
Mailing address:
  • Phone: 810-487-3500
  • Fax: 810-487-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301064203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: