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General NPI Number Information
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NPI Number | 1225317399
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Entity Type | Individual
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Provider Name | MUSAB EM T NUSRAT MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 1821 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-2253
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 4TH ST MS 9410
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City | LUBBOCK
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State | TX
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Zip | 79430-9410
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Country | US
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Telephone | 806-743-3155
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Fax | 806-743-3143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 68185-20
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License Number State | WI
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