Healthcare Provider Details

I. General information

NPI: 1336372010
Provider Name (Legal Business Name): MERSHED ALSAMARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 HEALTH DR SW
WYOMING MI
49519-9698
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-5950
  • Fax:
Mailing address:
  • Phone: 616-252-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60644313
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301093773
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60644313
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License NumberMD177136
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License NumberMD60644313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: