MEDICARE: MOHAMED NASSER 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	207R00000X	Internal Medicine Physician	4301506039	MI

General Provider Information

NPI Number	:	1558890277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED NASSER MD

Provider Business Mailing Address
First Line	:	22335 WATERLAND DR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-3500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2173
Country	:	US
Telephone Number	:	313-974-6533
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	04/06/2022

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