MEDICARE: SAMIR DABBOUS 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	207R00000X	Internal Medicine Physician	4301038418	MI
2	207RI0011X	Interventional Cardiology Physician	4301038418	MI
3	207UN0901X	Nuclear Cardiology Physician	4301038418	MI
4	207RC0000X	Cardiovascular Disease Physician	4301038418	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060007967	OTHER	MI	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0Q26305001	OTHER	MI	BLUECROSSBLUESHIELD OF MI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P41685	OTHER	MI	BLUECARENETWORK

General Provider Information

NPI Number	:	1538195664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIR DABBOUS M.D.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	22060 BEECH ST
Second Line	:	SUITE 200
City	:	DEARBORN
State	:	MI
Zip	:	48124-2847
Country	:	US
Telephone Number	:	313-228-0505
Fax Number	:	313-228-0506

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	10/22/2020

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