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NPI Code Detail

MEDICARE: SAM S. GABBARA M.D.

MEDICARE: SAM S. GABBARA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4301076223MI

General Provider Information

NPI Number : 1083709612
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAM S. GABBARA M.D.
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 23133 ORCHARD LAKE RD
Second Line : SUITE 100
City : FARMINGTON HILLS
State : MI
Zip : 48336-3268
Country : US
Telephone Number : 248-477-0100
Fax Number : 248-477-6153
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 02/16/2026

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