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General NPI Number Information
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NPI Number | 1659774172
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Entity Type | Individual
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Provider Name | GORDAN SAMOUKOVIC MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1500 E MEDICAL CENTER DRIVE 3RD FLOOR CARDIOVASCULAR CENTER RECP C
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City | ANN ARBOR
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State | MI
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Zip | 48109-5864
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Country | US
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Telephone | 888-287-1082
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301105602
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 4301105602
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License Number State | MI
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