Individual
DR. ASAD EHTISHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15396 N 83RD AVE STE E, PEORIA, AZ 85381-5627
(623) 300-3684
Mailing address
PO BOX 43108, PHOENIX, AZ 85080-3108
(602) 663-0993
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
37736
KY
2084N0400X
Neurology Physician
Primary
48099
AZ
2084V0102X
Vascular Neurology Physician
37736
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000639847
ANTHEM - NNS
KY
01
—
000052152Q
HUMANA - NNS
KY
01
—
109615
SIHO - NNS
KY
05
—
200329930A
—
KS
05
—
200972890
—
IN
01
—
50028054
PASSPORT & PASSPORT ADV - NNS
KY
01
—
5128838
CIGNA - NNS
KY
05
—
7100096130
—
KY
01
—
7601540
AETNA - NNS
KY
Enumeration date
06/15/2005
Last updated
08/07/2020
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