MEDICARE: NUSRATH FATIMA M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1154258127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUSRATH FATIMA M.D.

Provider Business Mailing Address
First Line	:	H.NO 10-6-61,AHMED NAGAR, BAZAR, ASIF NAGAR
Second Line	:
City	:	HYDERABAD
State	:	TELANGANA
Zip	:	500058
Country	:	IN
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 W OUTER DRIVE, SINAI GRACE HOSPITAL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235
Country	:	US
Telephone Number	:	313-966-3250
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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