Healthcare Provider Details

I. General information

NPI: 1619883733
Provider Name (Legal Business Name): KARIM GHISHAN BDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W LAKE LANSING RD STE 100
EAST LANSING MI
48823-8486
US

IV. Provider business mailing address

1200 BROADWAY ST APT 508
ANN ARBOR MI
48105-2985
US

V. Phone/Fax

Practice location:
  • Phone: 517-336-9880
  • Fax:
Mailing address:
  • Phone: 319-981-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901603259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: