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General NPI Number Information
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NPI Number | 1710150909
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Entity Type | Organization
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Legal Business Name | NUSRAT RAHMAN MD PC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 3781 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-4118
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Country | US
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Telephone | 313-381-7430
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Fax | 313-381-7958
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Provider Business Mailing Address
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Address Line | 3781 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-4118
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Country | US
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Telephone | 313-381-7430
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Fax | 313-381-7958
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NUSRAT Z RAHMAN
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Credential | M.D.
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Telephone | 313-590-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | SR033102
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NR043492
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License Number State | MI
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