Provider Demographics
NPI:1578867404
Name:YAQOUB SARSAM, MUTHER DAWOOD (MD)
Entity Type:Individual
Prefix:
First Name:MUTHER
Middle Name:DAWOOD
Last Name:YAQOUB SARSAM
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 1:6840 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1702
Mailing Address - Country:US
Mailing Address - Phone:313-846-1700
Mailing Address - Fax:313-846-2717
Practice Address - Street 1:6840 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1702
Practice Address - Country:US
Practice Address - Phone:313-846-1700
Practice Address - Fax:313-846-2717
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine