Healthcare Provider Details

I. General information

NPI: 1437219391
Provider Name (Legal Business Name): SAMEER ABDURRAHMAN HURAIBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 W VERNOR HWY
DETROIT MI
48216-1551
US

IV. Provider business mailing address

3456 W VERNOR HWY
DETROIT MI
48216-1551
US

V. Phone/Fax

Practice location:
  • Phone: 313-254-9693
  • Fax: 734-629-1567
Mailing address:
  • Phone: 313-254-9693
  • Fax: 734-629-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301085918
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: