Provider Demographics
NPI:1033198593
Name:CARDIOLOGY ASSOC OF PORT HURON
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOC OF PORT HURON
Other - Org Name:PORT HURON HEART CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-985-9681
Mailing Address - Street 1:44201 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1117
Mailing Address - Country:US
Mailing Address - Phone:248-964-5000
Mailing Address - Fax:
Practice Address - Street 1:1222 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3406
Practice Address - Country:US
Practice Address - Phone:810-985-9681
Practice Address - Fax:810-985-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048340207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI770G460150OtherBLUE CROSS BLUE SHIELD
MI3066919Medicaid