Healthcare Provider Details

I. General information

NPI: 1780314435
Provider Name (Legal Business Name): SAEED BASHEER SUFYAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E KALAMAZOO ST
LANSING MI
48912-2701
US

IV. Provider business mailing address

2191 MEADOWLAWN DR APT B
HOLT MI
48842-1242
US

V. Phone/Fax

Practice location:
  • Phone: 517-862-2915
  • Fax:
Mailing address:
  • Phone: 517-410-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: