Provider Demographics
NPI:1952968919
Name:MANASRAH, NOURALDEEN ADNAN RASHED (MD)
Entity Type:Individual
Prefix:MR
First Name:NOURALDEEN
Middle Name:ADNAN RASHED
Last Name:MANASRAH
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 1:6071 W. OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:313-966-7434
Mailing Address - Fax:313-966-8863
Practice Address - Street 1:6071 W. OUTER DRIVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-7434
Practice Address - Fax:313-966-8863
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-01-28
Deactivation Date:2020-01-16
Deactivation Code:
Reactivation Date:2020-01-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program