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General NPI Number Information
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NPI Number | 1396879730
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Entity Type | Organization
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Legal Business Name | ASIF ISHAQUE MD PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 9244 LAPEER RD
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City | DAVISON
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State | MI
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Zip | 48423-1757
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Country | US
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Telephone | 810-653-2111
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Fax | 810-653-8506
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Provider Business Mailing Address
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Address Line | 9244 LAPEER RD
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City | DAVISON
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State | MI
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Zip | 48423-1757
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Country | US
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Telephone | 810-653-2111
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Fax | 810-653-8506
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Authorized Official
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Title or Position | OWNER
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Name | DR. ASIF ISHAQUE
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Credential | MD
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Telephone | 810-653-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301062301
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License Number State | MI
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