Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 4301051703 | MI |
NPI | 1063453413 |
---|---|
Provider Name | Samir Alsawah |
First Address | Port Huron, MI 48060-3500 |
Second Address | Port Huron, MI 48060-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110G41039 | BCBSM ALSAWAH (01) | MI |
3165470 | (05) | MI |
F56486 | (02) | MI |
P78652 | BCN (01) | MI |