Healthcare Provider Details

I. General information

NPI: 1861736027
Provider Name (Legal Business Name): SCOTT SAMI SAMONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23405 PLYMOUTH RD
REDFORD MI
48239-1433
US

IV. Provider business mailing address

1400 EUREKA RD
WYANDOTTE MI
48192-6102
US

V. Phone/Fax

Practice location:
  • Phone: 313-694-3101
  • Fax: 313-344-7544
Mailing address:
  • Phone: 734-888-4454
  • Fax: 313-344-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301101291
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number4301101291
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301101291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: