Provider Demographics
NPI:1548641582
Name:AL-SMOUDI, SARIEA (DO)
Entity type:Individual
Prefix:
First Name:SARIEA
Middle Name:
Last Name:AL-SMOUDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 DIX
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1529
Mailing Address - Country:US
Mailing Address - Phone:313-843-6375
Mailing Address - Fax:
Practice Address - Street 1:27450 SCHOENHERR RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-582-7550
Practice Address - Fax:586-582-7515
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine