Provider Demographics
NPI:1164234639
Name:GREENWARREN FAMILY CLINIC
Entity type:Organization
Organization Name:GREENWARREN FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:HOMISHA
Authorized Official - Suffix:
Authorized Official - Credentials:SAMER I HOMISHA
Authorized Official - Phone:313-420-8300
Mailing Address - Street 1:23120 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1853
Mailing Address - Country:US
Mailing Address - Phone:313-420-8300
Mailing Address - Fax:
Practice Address - Street 1:15401 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1359
Practice Address - Country:US
Practice Address - Phone:313-420-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty