Provider Demographics
NPI:1396776043
Name:MORKOS, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:MORKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSSAMA
Other - Middle Name:ROUSHDY
Other - Last Name:MORKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 660857
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0857
Mailing Address - Country:US
Mailing Address - Phone:855-709-4498
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1900 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6880
Practice Address - Country:US
Practice Address - Phone:989-894-3077
Practice Address - Fax:989-894-6138
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080918207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00836690OtherRAILROAD
MI0500910182OtherBCBS
MI1396776043Medicaid
MI0500910182OtherBCBS
H51094Medicare UPIN