Provider Demographics
NPI:1659550952
Name:MAKHOUL, SAMI (DC)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:MAKHOUL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26421 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4528
Mailing Address - Country:US
Mailing Address - Phone:248-905-5066
Mailing Address - Fax:248-905-5069
Practice Address - Street 1:154 E HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1313
Practice Address - Country:US
Practice Address - Phone:989-269-7011
Practice Address - Fax:989-269-7053
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C20021OtherBCBS
MI950C20021OtherBCBS