Healthcare Provider Details

I. General information

NPI: 1972581908
Provider Name (Legal Business Name): MUNZER SAMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26411 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4528
US

IV. Provider business mailing address

26411 SOUTHFIELD RD
LATHRUP VILLAGE MI
48076-4528
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-8195
  • Fax: 248-552-8537
Mailing address:
  • Phone: 248-552-8195
  • Fax: 248-552-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301061568
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301061568
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: