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General NPI Number Information
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NPI Number | 1124606751
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Entity Type | Individual
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Provider Name | DAVID JOSEPH SAMRAH MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 31200 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-1344
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Country | US
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Telephone | 586-939-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 918 COUNTRY CLUB DR
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-2929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301511171
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License Number State | MI
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