Provider Demographics
NPI:1780468710
Name:KHOUCHEN, ASHRAF
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:KHOUCHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23252 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1358
Mailing Address - Country:US
Mailing Address - Phone:313-516-6255
Mailing Address - Fax:
Practice Address - Street 1:19925 VERNIER RD STE 200
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1486
Practice Address - Country:US
Practice Address - Phone:313-468-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG07230055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner