MEDICARE: DR. SASENARINE S PERSAUD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301062060	MI

General Provider Information

NPI Number	:	1013908573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SASENARINE S PERSAUD MD

Provider Business Mailing Address
First Line	:	314 N MAIN ST
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-1525
Country	:	US
Telephone Number	:	248-577-0600
Fax Number	:	248-577-0601

Provider Business Practice Location Address
First Line	:	314 N MAIN ST
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-1525
Country	:	US
Telephone Number	:	248-577-0600
Fax Number	:	248-577-0601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	11/14/2012

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