Provider Demographics
NPI:1508129339
Name:NASR, JUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:NASR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE400-CREDENTIALING DEPARTMENT
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-601-6945
Mailing Address - Fax:586-264-0341
Practice Address - Street 1:37771 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2302
Practice Address - Country:US
Practice Address - Phone:248-601-6945
Practice Address - Fax:586-264-0341
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2022-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301100604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine