Provider Demographics
NPI:1649461492
Name:GEOFFEY M SAHAM, M.D.P C
Entity type:Organization
Organization Name:GEOFFEY M SAHAM, M.D.P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:248-828-7500
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0966
Mailing Address - Country:US
Mailing Address - Phone:248-828-7500
Mailing Address - Fax:
Practice Address - Street 1:115 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5524
Practice Address - Country:US
Practice Address - Phone:248-828-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGS063481207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIGS063481OtherSTATE LICENSE
MI4529087Medicaid
MI4529087Medicaid