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General NPI Number Information
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NPI Number | 1972691152
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Entity Type | Organization
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Legal Business Name | NASR PSYCHIATRIC SERVICES, P.C.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2814 FRANKLIN ST
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-6140
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Country | US
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Telephone | 219-872-1500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8852
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City | MICHIGAN CITY
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State | IN
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Zip | 46361-8852
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Country | US
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Telephone | 219-872-1500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. SUHAYL JOSEPH NASR
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Credential | M.D.
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Telephone | 219-872-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 50003224
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License Number State | IN
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