Provider Demographics
NPI:1184220949
Name:M SARSAM MD PLLC
Entity Type:Organization
Organization Name:M SARSAM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-846-1700
Mailing Address - Street 1:6840 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1702
Mailing Address - Country:US
Mailing Address - Phone:313-846-1700
Mailing Address - Fax:
Practice Address - Street 1:6840 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1702
Practice Address - Country:US
Practice Address - Phone:313-846-1700
Practice Address - Fax:313-846-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty