Healthcare Provider Details

I. General information

NPI: 1770165706
Provider Name (Legal Business Name): SAMI HOUSSIN HOURIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18598 BUSINESS 13
BRANSON WEST MO
65737-9659
US

IV. Provider business mailing address

1600 23RD AVE
GREELEY CO
80634-6070
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-8497
  • Fax:
Mailing address:
  • Phone: 970-810-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0069665
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023045060
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: