Provider Demographics
NPI:1225312895
Name:SD CARDIOVASCULAR P C
Entity Type:Organization
Organization Name:SD CARDIOVASCULAR P C
Other - Org Name:DEARBORN CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:ABDALLAH
Authorized Official - Last Name:DABBOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-3640
Mailing Address - Street 1:22060 BEECH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2847
Mailing Address - Country:US
Mailing Address - Phone:313-563-3640
Mailing Address - Fax:313-724-1885
Practice Address - Street 1:22060 BEECH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2847
Practice Address - Country:US
Practice Address - Phone:313-563-3640
Practice Address - Fax:313-724-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038418207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H27352OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIDS2983OtherMEDICARE RAILROAD
MIMI5097Medicare PIN