Provider Demographics
NPI:1629475066
Name:SARAKBI, HOUSAM ALDEEN (MD)
Entity Type:Individual
Prefix:
First Name:HOUSAM
Middle Name:ALDEEN
Last Name:SARAKBI
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 1:400 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 917
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-0011
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113943207R00000X, 207RR0500X
WI40639-020207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1629475066Medicaid
WISARAKHOUOtherMERCYCARE INSURANCE
WI1629475066OtherBCBSWI
WISARAKHOUOtherMERCYCARE INSURANCE