Individual
DR. SUSAN A NASRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5734 COVENTRY LN, FORT WAYNE, IN 46804-7141
(260) 436-7875
(260) 432-9812
Mailing address
2914 S REPUBLIC BLVD, TOLEDO, OH 43615-1912
(419) 531-8808
(419) 531-9342
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01052481
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050087310
RAILROAD MEDICARE
IN
01
—
163855
CSHCS
IN
01
—
163856
CSHCS
IN
01
—
163857
CSHCS
IN
05
—
200357570
—
IN
Enumeration date
07/12/2005
Last updated
11/20/2014
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