Provider Demographics
NPI:1326535667
Name:BEYDOUN, FATIMA SAMIR
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:SAMIR
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27420
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2026
Mailing Address - Country:US
Mailing Address - Phone:586-216-7523
Mailing Address - Fax:248-324-1261
Practice Address - Street 1:42931 7 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-348-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151011526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine