Provider Demographics
NPI:1437219391
Name:HURAIBI, SAMEER ABDURRAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:ABDURRAHMAN
Last Name:HURAIBI
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 1:3456 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1551
Mailing Address - Country:US
Mailing Address - Phone:313-254-9693
Mailing Address - Fax:734-629-1567
Practice Address - Street 1:3456 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1551
Practice Address - Country:US
Practice Address - Phone:313-254-9693
Practice Address - Fax:734-629-1567
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11881046OtherCAQH
MI1437219391Medicaid
MI1437219391OtherBCBS TYPE 1 (IND) NPI #
MI4301085918OtherSTATE LICENSE #
MI509502572OtherBCBS TYPE 1 PIN # IND
MIP00862490OtherRAILROAD MEDICARE
MIMI3009001OtherMEDICARE IND PIN #
MI5315038149OtherCDS #