Provider Demographics
NPI:1487227021
Name:AZIZ, SAMIR ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:ABDUL
Last Name:AZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMIR
Other - Middle Name:MOHAMMED
Other - Last Name:ABDULAZIZ ABDULSATTAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2799 WEST GRAND BOULEVARD, HENRY FORD HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-1601
Mailing Address - Fax:
Practice Address - Street 1:2799 WEST GRAND BOULEVARD, HENRY FORD HOSPITAL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351047909390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program