Provider Demographics
NPI:1619187275
Name:WARRA, NADER (DO)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:WARRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5011
Mailing Address - Country:US
Mailing Address - Phone:248-478-5512
Mailing Address - Fax:248-478-5350
Practice Address - Street 1:27555 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5011
Practice Address - Country:US
Practice Address - Phone:248-478-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010160012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13-5-63-2045-4OtherBCBS INDIVIDUAL PIN
MI700F310510OtherBCBS GROUP NUMBER
MI1619187275Medicaid
MI5101016001OtherMI PHYSICAN LICENSE NUMBER
MIM06400016Medicare PIN