MEDICARE: SAMAR ELACHKAR MD

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	4301076272	MI

General Provider Information

NPI Number	:	1902946841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAR ELACHKAR MD

Provider Business Mailing Address
First Line	:	29200 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-2228
Country	:	US
Telephone Number	:	734-252-3424
Fax Number	:	248-650-1369

Provider Business Practice Location Address
First Line	:	29200 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-2228
Country	:	US
Telephone Number	:	734-523-2420
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/11/2021

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