Provider Demographics
NPI:1912993924
Name:NUSRAT, SAJEDA (MD)
Entity Type:Individual
Prefix:
First Name:SAJEDA
Middle Name:
Last Name:NUSRAT
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 1:3310 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3263
Mailing Address - Country:US
Mailing Address - Phone:989-249-4040
Mailing Address - Fax:989-249-4045
Practice Address - Street 1:3310 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3263
Practice Address - Country:US
Practice Address - Phone:989-249-4040
Practice Address - Fax:989-249-4045
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4771555Medicaid
MIMI5730001OtherMEDICARE
MI0731162OtherBCBSM INDIVIDUAL
MI080G303650OtherBCBSM
MII39765Medicare UPIN