Provider Demographics
NPI:1265518567
Name:YASIN, NURA F (MD)
Entity type:Individual
Prefix:
First Name:NURA
Middle Name:F
Last Name:YASIN
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 1:1604 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1547
Mailing Address - Country:US
Mailing Address - Phone:913-279-0600
Mailing Address - Fax:
Practice Address - Street 1:1111 GARREDD BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6751
Practice Address - Country:US
Practice Address - Phone:706-863-5776
Practice Address - Fax:706-868-7057
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092485207Q00000X
MIL2114580207Q00000X
KS0431966207Q00000X
GA84792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100216770CMedicaid
KSF200000Medicare PIN
KS100216770CMedicaid
KSF20E935Medicare PIN