Provider Demographics
NPI:1578711636
Name:ALSAMSAM, ADHAM (MD)
Entity Type:Individual
Prefix:
First Name:ADHAM
Middle Name:
Last Name:ALSAMSAM
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 1:22255 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3710
Mailing Address - Country:US
Mailing Address - Phone:248-849-2710
Mailing Address - Fax:248-849-4024
Practice Address - Street 1:22255 GREENFIELD RD STE 350
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3712
Practice Address - Country:US
Practice Address - Phone:248-849-2710
Practice Address - Fax:248-849-4024
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092834207V00000X, 390200000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program