Provider Demographics
NPI:1013908573
Name:PERSAUD, SASENARINE S (MD)
Entity Type:Individual
Prefix:DR
First Name:SASENARINE
Middle Name:S
Last Name:PERSAUD
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 1:314 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1525
Mailing Address - Country:US
Mailing Address - Phone:248-577-0600
Mailing Address - Fax:248-577-0601
Practice Address - Street 1:314 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1525
Practice Address - Country:US
Practice Address - Phone:248-577-0600
Practice Address - Fax:248-577-0601
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G51859Medicare UPIN
0N12570Medicare ID - Type Unspecified