MEDICARE: NASEEB BISHARA HAMAMEH 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	2080A0000X	Pediatric Adolescent Medicine Physician	37199	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0820651	OTHER	MI	BCBS OF MI.

General Provider Information

NPI Number	:	1548205347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASEEB BISHARA HAMAMEH M.D.

Provider Business Mailing Address
First Line	:	22350 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2421
Country	:	US
Telephone Number	:	313-278-2788
Fax Number	:	313-278-8215

Provider Business Practice Location Address
First Line	:	22350 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2421
Country	:	US
Telephone Number	:	313-278-2788
Fax Number	:	313-278-8215

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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