Healthcare Provider Details

I. General information

NPI: 1013908573
Provider Name (Legal Business Name): SASENARINE S PERSAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N MAIN ST
CLAWSON MI
48017-1525
US

IV. Provider business mailing address

314 N MAIN ST
CLAWSON MI
48017-1525
US

V. Phone/Fax

Practice location:
  • Phone: 248-577-0600
  • Fax: 248-577-0601
Mailing address:
  • Phone: 248-577-0600
  • Fax: 248-577-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: