Provider Demographics
NPI:1467548891
Name:ZEBARI, SAMIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:
Last Name:ZEBARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28500 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2722
Mailing Address - Country:US
Mailing Address - Phone:248-557-0160
Mailing Address - Fax:248-557-1756
Practice Address - Street 1:28500 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2722
Practice Address - Country:US
Practice Address - Phone:248-557-0160
Practice Address - Fax:248-557-1756
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISZ046484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1491727Medicaid
MI001094OtherMIDWEST HEALTH PLAN
MI104782OtherGREAT LAKES HEALTH PLAN
MI1436OtherCAPE
MI3506313552OtherBCBSM
MI1491727Medicaid