Healthcare Provider Details

I. General information

NPI: 1629252689
Provider Name (Legal Business Name): SAMER GEORGE SAQQA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23829 LITTLE MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-1186
US

IV. Provider business mailing address

24715 LITTLE MACK AVE SUITE 100
SAINT CLAIR SHORES MI
48080-3207
US

V. Phone/Fax

Practice location:
  • Phone: 586-773-1300
  • Fax: 586-773-1600
Mailing address:
  • Phone: 586-779-7970
  • Fax: 586-778-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number5101016012
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101016012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: