Provider Demographics
NPI:1346667110
Name:ROCHESTER DIGESTIVE DISEASE GROUP PC
Entity Type:Organization
Organization Name:ROCHESTER DIGESTIVE DISEASE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-HADIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-844-2600
Mailing Address - Street 1:PO BOX 71066
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-0020
Mailing Address - Country:US
Mailing Address - Phone:248-844-2600
Mailing Address - Fax:248-844-0991
Practice Address - Street 1:75 BARCLAY CIRCLE
Practice Address - Street 2:STE 205
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-0020
Practice Address - Country:US
Practice Address - Phone:248-844-2600
Practice Address - Fax:248-844-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOA3032314207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5033002Medicare PIN