Provider Demographics
NPI:1780314435
Name:SUFYAN, SAEED BASHEER (PA)
Entity type:Individual
Prefix:MR
First Name:SAEED
Middle Name:BASHEER
Last Name:SUFYAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 MEADOWLAWN DR APT B
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1242
Mailing Address - Country:US
Mailing Address - Phone:517-410-1254
Mailing Address - Fax:
Practice Address - Street 1:1601 E KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2701
Practice Address - Country:US
Practice Address - Phone:517-862-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program