Healthcare Provider Details

I. General information

NPI: 1255738167
Provider Name (Legal Business Name): RASHA SAMER KESTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RASHA SAMER KESTO PA-C

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

555 S OLD WOODWARD AVE APT 803
BIRMINGHAM MI
48009-6673
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4311
  • Fax: 248-465-4651
Mailing address:
  • Phone: 248-921-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: