Provider Demographics
NPI:1558530030
Name:SAMIR R. YAHIA MD,P.C
Entity Type:Organization
Organization Name:SAMIR R. YAHIA MD,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:YAHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-343-0304
Mailing Address - Street 1:22151 MOROSS RD BLDG 1
Mailing Address - Street 2:SUITE 335
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2167
Mailing Address - Country:US
Mailing Address - Phone:313-343-0304
Mailing Address - Fax:313-343-0556
Practice Address - Street 1:22151 MOROSS RD BLDG 1
Practice Address - Street 2:SUITE 335
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2167
Practice Address - Country:US
Practice Address - Phone:313-343-0304
Practice Address - Fax:313-343-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0823255Medicare PIN