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General NPI Number Information
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NPI Number | 1669703799
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Entity Type | Organization
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Legal Business Name | BEAUMONT KIDNEY SPECIALTY SERVICES LLC
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 26400 W 12 MILE RD SUITE 112
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1700
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Country | US
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Telephone | 248-457-7648
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Fax |
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Provider Business Mailing Address
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Address Line | 26400 W 12 MILE RD SUITE 112
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1700
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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 | PRESIDENT
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Name | DR. SAMI SALEH ZAROUK
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Credential | MD
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Telephone | 248-457-7648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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