Provider Demographics
NPI:1558445437
Name:SAED J SAHOURI MD PLLC
Entity Type:Organization
Organization Name:SAED J SAHOURI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAED
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-4200
Mailing Address - Street 1:1020 CHARTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3584
Mailing Address - Country:US
Mailing Address - Phone:810-720-4200
Mailing Address - Fax:810-720-2711
Practice Address - Street 1:1020 CHARTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3584
Practice Address - Country:US
Practice Address - Phone:810-720-4200
Practice Address - Fax:810-720-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301056025OtherLICENSE
MI0P27200Medicare PIN
MI4301056025OtherLICENSE