Provider Demographics
NPI:1669703799
Name:BEAUMONT KIDNEY SPECIALTY SERVICES LLC
Entity type:Organization
Organization Name:BEAUMONT KIDNEY SPECIALTY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:SALEH
Authorized Official - Last Name:ZAROUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-457-7648
Mailing Address - Street 1:26400 W 12 MILE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1700
Practice Address - Country:US
Practice Address - Phone:248-457-7648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment