Provider Demographics
NPI:1265687321
Name:MILLENIUM NORTH PC
Entity Type:Organization
Organization Name:MILLENIUM NORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:ASMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-9323
Mailing Address - Street 1:3400 FLECKENSTEIN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3043
Mailing Address - Country:US
Mailing Address - Phone:810-230-9323
Mailing Address - Fax:810-230-9328
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3043
Practice Address - Country:US
Practice Address - Phone:810-230-9323
Practice Address - Fax:810-230-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4649370Medicaid
MIG61684Medicare UPIN