Healthcare Provider Details

I. General information

NPI: 1710150909
Provider Name (Legal Business Name): NUSRAT RAHMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3781 FORT ST
LINCOLN PARK MI
48146-4118
US

IV. Provider business mailing address

3781 FORT ST
LINCOLN PARK MI
48146-4118
US

V. Phone/Fax

Practice location:
  • Phone: 313-381-7430
  • Fax: 313-381-7958
Mailing address:
  • Phone: 313-381-7430
  • Fax: 313-381-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNR043492
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberSR033102
License Number StateMI

VIII. Authorized Official

Name: MRS. NUSRAT Z RAHMAN
Title or Position: OWNER
Credential: M.D.
Phone: 313-590-7705