Provider Demographics
NPI:1063501591
Name:JAVAID, NUSRAT (MD)
Entity Type:Individual
Prefix:DR
First Name:NUSRAT
Middle Name:
Last Name:JAVAID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRICIANS
Mailing Address - Street 2:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDREN'S HOSPITAL OF MI
Practice Address - Street 2:3901 BEAUBIEN - GROUND FL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5260
Practice Address - Fax:313-966-0665
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056997207PE0004X, 207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51090OtherBLUE SHIELD
MI4434887Medicaid
MI0B51090OtherBLUE SHIELD
MI0M54610037Medicare ID - Type Unspecified