Provider Demographics
NPI:1659305605
Name:SOTOUHI, SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:SOTOUHI
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 1:7145 APPOLINE ST
Mailing Address - Street 2:NEUROLOGY, HEADACHE & PAIN MANAGEMENT
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1991
Mailing Address - Country:US
Mailing Address - Phone:313-581-0003
Mailing Address - Fax:313-581-3399
Practice Address - Street 1:7145 APPOLINE ST
Practice Address - Street 2:NEUROLOGY, HEADACHE & PAIN MANAGEMENT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1991
Practice Address - Country:US
Practice Address - Phone:313-581-0003
Practice Address - Fax:313-581-3399
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010448042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1308255022OtherBLUE CROSS BLUE SHEILD
MI4880228Medicaid
MI0P30010Medicare PIN
MID54110Medicare UPIN