Healthcare Provider Details

I. General information

NPI: 1285600296
Provider Name (Legal Business Name): DEMIAN IBRAHIM NAGUIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 STONE ST SUITE 1
PORT HURON MI
48060-3525
US

IV. Provider business mailing address

1117 STONE ST SUITE 1
PORT HURON MI
48060-3525
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-9699
  • Fax: 810-985-9694
Mailing address:
  • Phone: 810-985-9699
  • Fax: 810-985-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301076835
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301076835
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number5315052553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: