Provider Demographics
NPI:1710150909
Name:NUSRAT RAHMAN MD PC
Entity Type:Organization
Organization Name:NUSRAT RAHMAN MD PC
Other - Org Name:S.M. RAHMAN MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-590-7705
Mailing Address - Street 1:3781 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-4118
Mailing Address - Country:US
Mailing Address - Phone:313-381-7430
Mailing Address - Fax:313-381-7958
Practice Address - Street 1:3781 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4118
Practice Address - Country:US
Practice Address - Phone:313-381-7430
Practice Address - Fax:313-381-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINR043492207R00000X
MISR033102208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1092811 TYPE10Medicaid
MI110 8222342OtherBCBS
MI2124310 TYPE10Medicaid
MI0208208989OtherBCBS
MI2124310 TYPE10Medicaid
MI110 8222342OtherBCBS
MIA74045Medicare UPIN
MI0208208989OtherBCBS