MEDICARE: CARDIOLOGY ASSOC OF PORT HURON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4301048340	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770G460150	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033198593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY ASSOC OF PORT HURON

Provider Business Mailing Address
First Line	:	44201 DEQUINDRE RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1117
Country	:	US
Telephone Number	:	248-964-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 10TH AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3406
Country	:	US
Telephone Number	:	810-985-9681
Fax Number	:	810-985-3590

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BASHAR SAMMAN
Credential	:	MD
Telephone Number	:	810-985-9681

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/17/2022

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