Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lara Nassar

Individual provider Physician Assistant · NPI 1780487561

Lara Nassar is a Physician Assistant in Southfield, Michigan. Qualified in 2025, 1 year ago. Works from 2 locations. Licensed in Michigan.

Years since qualifying
1
Licensed in
MI
In the registry since
2025
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Practice location Address checks out

21000 W 10 Mile Rd
Southfield, MI 48075-1051
Phone: (313) 380-0527
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3901 Beaubien St, Detroit, MI 48201-2119 — (313) 745-5870

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601013454 (MI)

Record details

NPI number1780487561
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 28, 2025
Last updated in NPPESDecember 3, 2025
Certification dateDecember 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Southfield