Provider Demographics
NPI:1255738167
Name:KESTO, RASHA SAMER (PA-C)
Entity type:Individual
Prefix:MS
First Name:RASHA
Middle Name:SAMER
Last Name:KESTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RASHA
Other - Middle Name:SAMER
Other - Last Name:KESTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:555 S OLD WOODWARD AVE APT 803
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6673
Mailing Address - Country:US
Mailing Address - Phone:248-921-4087
Mailing Address - Fax:
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4311
Practice Address - Fax:248-465-4651
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant