Provider Demographics
NPI:1053387175
Name:ANSARI, ASAD (MD)
Entity type:Individual
Prefix:
First Name:ASAD
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL STE 5550
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1169
Practice Address - Country:US
Practice Address - Phone:574-647-2550
Practice Address - Fax:574-647-1129
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01065535A2080P0208X, 2080S0012X, 2080P0214X
MI43015060672080P0214X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200928890Medicaid
MI1053387175Medicaid