Provider Demographics
NPI:1376171538
Name:ALNASRY, MAZIN (MD)
Entity type:Individual
Prefix:
First Name:MAZIN
Middle Name:
Last Name:ALNASRY
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 1:35 MICHIGAN ST NE # MC177
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2514
Mailing Address - Country:US
Mailing Address - Phone:313-908-0407
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN ST NE # MC177
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2514
Practice Address - Country:US
Practice Address - Phone:313-908-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2025-05-07
Deactivation Date:2022-04-06
Deactivation Code:
Reactivation Date:2022-09-12
Provider Licenses
StateLicense IDTaxonomies
TX2019026548390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program