MEDICARE: JUSTINE NASR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301100604	MI

General Provider Information

NPI Number	:	1508129339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE NASR MD

Provider Business Mailing Address
First Line	:	1560 E MAPLE RD
Second Line	:	SUITE400-CREDENTIALING DEPARTMENT
City	:	TROY
State	:	MI
Zip	:	48083-1138
Country	:	US
Telephone Number	:	248-601-6945
Fax Number	:	586-264-0341

Provider Business Practice Location Address
First Line	:	37771 SCHOENHERR RD
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48312-2302
Country	:	US
Telephone Number	:	248-601-6945
Fax Number	:	586-264-0341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	07/29/2022

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