Healthcare Provider Details

I. General information

NPI: 1437149234
Provider Name (Legal Business Name): RON SAMARIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30400 TELEGRAPH RD 324
BINGHAM FARMS MI
48025-4537
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-540-4800
  • Fax: 248-540-4937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRS047614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: