Provider Demographics
NPI:1528287240
Name:NASIR, MOHSEN (MD)
Entity type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:NASIR
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 1:4200 FASHION SQUARE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1375
Mailing Address - Country:US
Mailing Address - Phone:989-729-4206
Mailing Address - Fax:989-729-4207
Practice Address - Street 1:4200 FASHION SQUARE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1375
Practice Address - Country:US
Practice Address - Phone:989-729-4206
Practice Address - Fax:989-729-4207
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097772207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528287240Medicaid