Provider Demographics
NPI:1073652806
Name:NACHAWATI, SAMER M (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:M
Last Name:NACHAWATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3330 NORTH GALLOWAY
Mailing Address - Street 2:STE 304
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4767
Mailing Address - Country:US
Mailing Address - Phone:972-352-3201
Mailing Address - Fax:214-660-2525
Practice Address - Street 1:929 N GALLOWAY AVE STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2400
Practice Address - Country:US
Practice Address - Phone:972-352-3203
Practice Address - Fax:214-660-2525
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9689207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114766519Medicaid