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General NPI Number Information
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NPI Number | 1295945996
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Entity Type | Individual
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Provider Name | SAMUEL T. FAWAZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | TRINITY HEALTH IHA MEDICAL GROUP PRIMARY CARE FREEDOM 20206 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152
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Country | US
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Telephone | 248-476-4724
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Fax | 248-476-7091
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DRIVE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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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 | ME150730
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301084045
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License Number State | MI
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