Provider Demographics
NPI:1760669303
Name:SAMIR SETOUHI MD PC
Entity type:Organization
Organization Name:SAMIR SETOUHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOUHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, BC
Authorized Official - Phone:313-581-0003
Mailing Address - Street 1:7145 APPOLINE ST
Mailing Address - Street 2:NEUROLOGY, HEADACHE & PAIN MANAGEMENT
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1991
Mailing Address - Country:US
Mailing Address - Phone:313-581-0003
Mailing Address - Fax:313-581-3399
Practice Address - Street 1:7145 APPOLINE ST
Practice Address - Street 2:NEUROLOGY, HEADACHE & PAIN MANAGEMENT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1991
Practice Address - Country:US
Practice Address - Phone:313-581-0003
Practice Address - Fax:313-581-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1308255022OtherBCBS
MI4880228Medicaid
MI4880228Medicaid
MIOP30010Medicare PIN