Healthcare Provider Details

I. General information

NPI: 1780242545
Provider Name (Legal Business Name): ALHAN BEYDOUN-SANEH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43347 RIVERBRIDGE CT
NOVI MI
48375-4722
US

IV. Provider business mailing address

43347 RIVERBRIDGE CT
NOVI MI
48375-4722
US

V. Phone/Fax

Practice location:
  • Phone: 313-675-9516
  • Fax:
Mailing address:
  • Phone: 313-675-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101026776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: