Provider Demographics
NPI:1043686215
Name:ALTAIRI, SAMAH ABDUL (PHD)
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:ABDUL
Last Name:ALTAIRI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 ROULO ST
Mailing Address - Street 2:SALTAIR2@HFHS.ORG
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120
Mailing Address - Country:US
Mailing Address - Phone:313-766-1965
Mailing Address - Fax:
Practice Address - Street 1:2939 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4825
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004744103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical