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General NPI Number Information
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NPI Number | 1164234639
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Entity Type | Organization
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Legal Business Name | GREENWARREN FAMILY CLINIC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 5237 OAKMAN BLVD STE E
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City | DEARBORN
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State | MI
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Zip | 48126-4045
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Country | US
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Telephone | 313-420-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 23120 WILSON AVE
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City | DEARBORN
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State | MI
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Zip | 48128-1853
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Country | US
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Telephone | 313-420-8300
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Fax |
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. SAMER IBRAHIM HOMISHA
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Credential | SAMER I. HOMISHA
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Telephone | 313-420-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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