Healthcare Provider Details

I. General information

NPI: 1467924407
Provider Name (Legal Business Name): JOHN E SAMANI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 N OPDYKE RD
AUBURN HILLS MI
48326-2641
US

IV. Provider business mailing address

3785 BAY RD
SAGINAW MI
48603-2433
US

V. Phone/Fax

Practice location:
  • Phone: 248-373-7600
  • Fax: 248-373-7443
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLI TAYLOR
Title or Position: CREDENTIALING MGR
Credential:
Phone: 989-791-2455