Healthcare Provider Details

I. General information

NPI: 1366547143
Provider Name (Legal Business Name): SAMER J BAHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44200 WOODWARD AVE SUITE 201
PONTIAC MI
48341-2985
US

IV. Provider business mailing address

44200 WOODWARD AVE SUITE 201
PONTIAC MI
48341-2985
US

V. Phone/Fax

Practice location:
  • Phone: 248-334-9490
  • Fax: 248-636-1170
Mailing address:
  • Phone: 248-334-9490
  • Fax: 248-636-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301068016
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: