Provider Demographics
NPI:1770663999
Name:RAHMAN, NUSRAT Z (MD)
Entity Type:Individual
Prefix:DR
First Name:NUSRAT
Middle Name:Z
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI043492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1108222342OtherBLUECROSS
MI2124310 TYPE10Medicaid
08222341111Medicare PIN
MIA74045Medicare UPIN
MI2124310 TYPE10Medicaid