Provider Demographics
NPI:1508654302
Name:BESADA, DAMIAN MINA (MD)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:MINA
Last Name:BESADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MINA
Other - Middle Name:SAMIR LOTFY
Other - Last Name:BESADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DRIVE 7PMB
Mailing Address - Street 2:SUITE #703A
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-849-3254
Mailing Address - Fax:248-849-5449
Practice Address - Street 1:22250 PROVIDENCE DRIVE 7PMB
Practice Address - Street 2:SUITE #703A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3254
Practice Address - Fax:248-849-5449
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program