Provider Demographics
NPI:1417965310
Name:SARAFA, NAZAR N (MD)
Entity Type:Individual
Prefix:
First Name:NAZAR
Middle Name:N
Last Name:SARAFA
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 1:1715 MIDDLEBELT ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135
Mailing Address - Country:US
Mailing Address - Phone:734-425-6363
Mailing Address - Fax:734-425-1337
Practice Address - Street 1:1715 MIDDLEBELT ROAD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:734-425-6363
Practice Address - Fax:734-425-1337
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINS043385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1610050Medicaid
MI1128209237111OtherBCBS MI
MI1128209237111OtherBCBS MI
B46429Medicare UPIN