Provider Demographics
NPI:1891431144
Name:SAJJAD, BUSHRA (MD)
Entity Type:Individual
Prefix:
First Name:BUSHRA
Middle Name:
Last Name:SAJJAD
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 1:200 JEFFERSON SE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-6741
Mailing Address - Fax:
Practice Address - Street 1:300 LAFAYETTE SE
Practice Address - Street 2:SUITE 4000
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-685-6922
Practice Address - Fax:616-685-5192
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351049079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program