Healthcare Provider Details

I. General information

NPI: 1033198593
Provider Name (Legal Business Name): CARDIOLOGY ASSOC OF PORT HURON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 10TH AVE
PORT HURON MI
48060-3406
US

IV. Provider business mailing address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-9681
  • Fax: 810-985-3590
Mailing address:
  • Phone: 248-964-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301048340
License Number StateMI

VIII. Authorized Official

Name: DR. BASHAR SAMMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 810-985-9681