MEDICARE: DR. MUNZER SAMAD 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	4301061568	MI
2	207Q00000X	Family Medicine Physician	4301061568	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	MS061568	OTHER	MI	BLUE CROSS LICENSE #

General Provider Information

NPI Number	:	1972581908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNZER SAMAD M.D.

Provider Business Mailing Address
First Line	:	26411 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-552-8195
Fax Number	:	248-552-8537

Provider Business Practice Location Address
First Line	:	26411 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-552-8195
Fax Number	:	248-552-8537

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/14/2025

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