Provider Demographics
NPI:1962472829
Name:SAREH, SAM NMI (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:NMI
Last Name:SAREH
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 1:333 NW 70TH AVE
Mailing Address - Street 2:#116
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-581-6041
Mailing Address - Fax:954-581-0222
Practice Address - Street 1:333 NW 70TH AVE
Practice Address - Street 2:#116
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-581-6041
Practice Address - Fax:954-581-0222
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270716100Medicaid
48897Medicare ID - Type Unspecified
I20048Medicare UPIN