Provider Demographics
NPI:1417941477
Name:SAKER, SAFWAN A (MD)
Entity Type:Individual
Prefix:
First Name:SAFWAN
Middle Name:A
Last Name:SAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2855
Mailing Address - Country:US
Mailing Address - Phone:866-969-3220
Mailing Address - Fax:248-274-5059
Practice Address - Street 1:2934 EAGLE CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2855
Practice Address - Country:US
Practice Address - Phone:866-969-3220
Practice Address - Fax:248-274-5059
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 4963367Medicaid
MI1108269021OtherBCBSM
G73788Medicare UPIN
MI1108269021OtherBCBSM