Provider Demographics
NPI:1558451211
Name:SAHOURI, SAED J (MD)
Entity Type:Individual
Prefix:
First Name:SAED
Middle Name:J
Last Name:SAHOURI
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 1:1020 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301056025OtherCONTROLLED SUBSTANCE
MI4301056025OtherLICENSE
23D1007216OtherCLIA
23D1007216OtherCLIA
BS3587675OtherDEA
23D1007216OtherCLIA