Provider Demographics
NPI:1437149234
Name:SAMARIAN, RON (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:SAMARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:324
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-540-4800
Practice Address - Fax:248-540-4937
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS0476142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3120719Medicaid
MI0635572Medicare ID - Type Unspecified
MI3120719Medicaid