Healthcare Provider Details

I. General information

NPI: 1487038139
Provider Name (Legal Business Name): SAMER HAJ-BAKRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2515
US

IV. Provider business mailing address

25 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2515
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-0800
  • Fax:
Mailing address:
  • Phone: 616-267-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301108122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: