Provider Demographics
NPI:1114236171
Name:NASR, KERELLOS ATHANACIOS-NABEH (MD)
Entity Type:Individual
Prefix:DR
First Name:KERELLOS
Middle Name:ATHANACIOS-NABEH
Last Name:NASR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4201 SAINT ANTOINE ST # 6D5.5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-966-8013
Mailing Address - Fax:313-993-2890
Practice Address - Street 1:4201 SAINT ANTOINE ST # 6D5.5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-966-8013
Practice Address - Fax:313-993-2890
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092883207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery