Healthcare Provider Details

I. General information

NPI: 1205222171
Provider Name (Legal Business Name): WASIM NASIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5097 MILLER RD STE 1
FLINT MI
48507-1043
US

IV. Provider business mailing address

5097 MILLER RD STE 1
FLINT MI
48507-1043
US

V. Phone/Fax

Practice location:
  • Phone: 833-322-3376
  • Fax: 248-607-6777
Mailing address:
  • Phone: 833-322-3376
  • Fax: 248-607-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301108257
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME136777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: