Provider Demographics
NPI:1912293978
Name:BEYDOUN, NADA SAMIR (DO)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:SAMIR
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 CENTERPOINT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3121
Mailing Address - Country:US
Mailing Address - Phone:248-333-2600
Mailing Address - Fax:248-333-3250
Practice Address - Street 1:3959 CENTERPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3121
Practice Address - Country:US
Practice Address - Phone:248-333-2600
Practice Address - Fax:248-333-3250
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2805350Medicaid