Provider Demographics
NPI:1700888179
Name:AJLUNI, SAM K (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:K
Last Name:AJLUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMEER
Other - Middle Name:
Other - Last Name:AJUNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26677 W. 12 MILE RD PMB 3272
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-434-4111
Mailing Address - Fax:248-288-3770
Practice Address - Street 1:26677 W. 12 MILE RD PMB 3272
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-434-4111
Practice Address - Fax:248-288-3770
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010721472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34953013Medicare ID - Type Unspecified
MIH38404Medicare UPIN