Provider Demographics
NPI:1083828750
Name:BAIRU, SAMUEL H (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:BAIRU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4410 W UNION HILLS DR
Mailing Address - Street 2:# 7, PMB # 280
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1660
Mailing Address - Country:US
Mailing Address - Phone:623-974-6611
Mailing Address - Fax:623-974-9434
Practice Address - Street 1:14502 W MEEKER BLVD
Practice Address - Street 2:PHYSICIAN IS A HOSPTIALIST ONLY
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5282
Practice Address - Country:US
Practice Address - Phone:206-290-2756
Practice Address - Fax:623-974-9434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA203365207RI0200X
AZ45091207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ664569Medicaid
AZ664569Medicaid