Healthcare Provider Details

I. General information

NPI: 1346667110
Provider Name (Legal Business Name): ROCHESTER DIGESTIVE DISEASE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIRCLE STE 205
ROCHESTER HILLS MI
48307-0020
US

IV. Provider business mailing address

PO BOX 71066
ROCHESTER HILLS MI
48307-0020
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-2600
  • 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 NumberOA3032314
License Number StateMI

VIII. Authorized Official

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