Provider Demographics
NPI:1811984594
Name:AWADA, SAM H (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:H
Last Name:AWADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3520
Mailing Address - Country:US
Mailing Address - Phone:586-751-2020
Mailing Address - Fax:586-751-7872
Practice Address - Street 1:12640 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3520
Practice Address - Country:US
Practice Address - Phone:586-751-2020
Practice Address - Fax:586-745-4756
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4905372Medicaid
MI4692522Medicaid
MI700E018250OtherBCBSM GROUP #
MI700E018250OtherBCBSM GROUP #
H67450Medicare UPIN