MEDICARE: MR. ALI MEHIEDDINE NASSRI

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	363LF0000X	Family Nurse Practitioner	F04220431	MI

General Provider Information

NPI Number	:	1912642869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALI MEHIEDDINE NASSRI

Provider Business Mailing Address
First Line	:	213 CORNELL ST
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1005
Country	:	US
Telephone Number	:	313-903-1776
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 CORNELL ST
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-1005
Country	:	US
Telephone Number	:	313-903-1776
Fax Number	:

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

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	02/02/2026

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