Provider Demographics
NPI:1740208651
Name:SAMHOURI, AHMAD M (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:M
Last Name:SAMHOURI
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 1:44038 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5035
Mailing Address - Country:US
Mailing Address - Phone:248-334-0050
Mailing Address - Fax:248-334-1368
Practice Address - Street 1:44038 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5035
Practice Address - Country:US
Practice Address - Phone:248-334-0050
Practice Address - Fax:248-334-1368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034418207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630008OtherBLUE CROSS OF MICHIGAN
MI0630008OtherBLUE CROSS OF MICHIGAN
0630008Medicare ID - Type Unspecified