Healthcare Provider Details

I. General information

NPI: 1861615452
Provider Name (Legal Business Name): PRIME MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 TOWN CENTER PKWY SUITE A
FLINT MI
48532-3425
US

IV. Provider business mailing address

4455 TOWN CENTER PKWY SUITE A
FLINT MI
48532-3425
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-3370
  • Fax: 810-720-3367
Mailing address:
  • Phone: 810-720-3370
  • Fax: 810-720-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301075121
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301085958
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number5101016443
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301062994
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704216332
License Number StateMI

VIII. Authorized Official

Name: SAMIR AQEL ELIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 810-720-3370