Healthcare Provider Details

I. General information

NPI: 1194997338
Provider Name (Legal Business Name): SAMER BAKHOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 06/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7534 HIGHWAY 1
LOCKPORT LA
70374-3437
US

IV. Provider business mailing address

21333 HAGGERTY RD. SUITE 150
NOVI MI
48375-5514
US

V. Phone/Fax

Practice location:
  • Phone: 800-979-9595
  • Fax: 248-662-9845
Mailing address:
  • Phone: 800-979-9595
  • Fax: 248-662-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number204682
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204682
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: