Healthcare Provider Details

I. General information

NPI: 1720249782
Provider Name (Legal Business Name): SAMIR AL-HADIDI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD SUITE 210
ROCHESTER HILLS MI
48307-5821
US

IV. Provider business mailing address

PO BOX 71066
ROCHESTER MI
48307-5821
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-0991
  • Fax: 248-844-0991
Mailing address:
  • Phone: 248-844-2600
  • Fax: 248-844-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberSA045286
License Number StateMI

VIII. Authorized Official

Name: SAMIR S AL-HADIDI
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 248-844-2600