Provider Demographics
NPI:1205222171
Name:NASIR, WASIM (MD)
Entity type:Individual
Prefix:
First Name:WASIM
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 1:5097 MILLER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1043
Mailing Address - Country:US
Mailing Address - Phone:833-322-3376
Mailing Address - Fax:248-607-6777
Practice Address - Street 1:5097 MILLER RD STE 1
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1043
Practice Address - Country:US
Practice Address - Phone:833-322-3376
Practice Address - Fax:248-607-6777
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108257207N00000X
FLME136777207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205222171Medicaid