Healthcare Provider Details

I. General information

NPI: 1740208651
Provider Name (Legal Business Name): AHMAD M SAMHOURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44038 WOODWARD AVE SUITE 101
BLOOMFIELD HILLS MI
48302-5035
US

IV. Provider business mailing address

44038 WOODWARD AVE SUITE 101
BLOOMFIELD HILLS MI
48302-5035
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-0050
  • Fax: 248-334-1368
Mailing address:
  • Phone: 248-334-0050
  • Fax: 248-334-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301034418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: