Healthcare Provider Details

I. General information

NPI: 1962996801
Provider Name (Legal Business Name): SAMI HASSEN HAMMOUD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax:
Mailing address:
  • Phone: 947-522-1848
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101025174
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.015697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: