MEDICARE: MOUTAMN SADOUN M.D.

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	208600000X	Surgery Physician	R73297	AZ
2	208600000X	Surgery Physician	4301111192	MI

General Provider Information

NPI Number	:	1528321809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOUTAMN SADOUN M.D.

Provider Business Mailing Address
First Line	:	29000 LITTLE MACK AVE STE B
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3018
Country	:	US
Telephone Number	:	586-774-8811
Fax Number	:	586-774-6773

Provider Business Practice Location Address
First Line	:	29000 LITTLE MACK AVE STE B
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3018
Country	:	US
Telephone Number	:	586-774-8811
Fax Number	:	586-774-6773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	07/21/2022

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