Provider Demographics
NPI:1295945996
Name:FAWAZ, SAMUEL T (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:FAWAZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:TRINITY HEALTH IHA MEDICAL GROUP PRIMARY CARE FREEDOM
Practice Address - Street 2:20206 FARMINGTON RD
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:248-476-4724
Practice Address - Fax:248-476-7091
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-02-29
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Provider Licenses
StateLicense IDTaxonomies
FLME150730207R00000X
MI4301084045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine