Provider Demographics
NPI:1912248493
Name:LATHRUP PRIMARY CARE PC
Entity type:Organization
Organization Name:LATHRUP PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUNZER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-552-8195
Mailing Address - Street 1:26631 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4530
Mailing Address - Country:US
Mailing Address - Phone:248-552-8195
Mailing Address - Fax:248-552-8537
Practice Address - Street 1:26631 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4530
Practice Address - Country:US
Practice Address - Phone:248-552-8195
Practice Address - Fax:248-552-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty