Provider Demographics
NPI:1629252689
Name:SAQQA, SAMER GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:GEORGE
Last Name:SAQQA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:24715 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3207
Mailing Address - Country:US
Mailing Address - Phone:586-779-7970
Mailing Address - Fax:586-778-2684
Practice Address - Street 1:23829 LITTLE MACK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1186
Practice Address - Country:US
Practice Address - Phone:586-773-1300
Practice Address - Fax:586-773-1600
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016012207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N45090OtherGRP MEDICARE
MI1629252689Medicaid
MI0M09460OtherGRP MEDICARE