Provider Demographics
NPI:1891883062
Name:NASR, SUHAYL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHAYL
Middle Name:JOSEPH
Last Name:NASR
Suffix:
Gender:M
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:PO BOX 8852
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46361-8852
Mailing Address - Country:US
Mailing Address - Phone:219-872-1500
Mailing Address - Fax:
Practice Address - Street 1:2814 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6140
Practice Address - Country:US
Practice Address - Phone:219-872-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010355262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100164160Medicaid
IN487590AMedicare ID - Type Unspecified
IN100164160Medicaid