Provider Demographics
NPI:1497097174
Name:ASSAAD, USAMA (MD)
Entity Type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:ASSAAD
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 1:900 E MICHIGAN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2490
Mailing Address - Country:US
Mailing Address - Phone:517-782-3190
Mailing Address - Fax:517-782-1223
Practice Address - Street 1:900 E MICHIGAN AVE STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2490
Practice Address - Country:US
Practice Address - Phone:517-782-3190
Practice Address - Fax:517-782-1223
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301110023207R00000X, 207RS0012X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program