Provider Demographics
NPI:1447941265
Name:HORANI, KASSEM SAMER
Entity type:Individual
Prefix:
First Name:KASSEM
Middle Name:SAMER
Last Name:HORANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10335 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1658
Mailing Address - Country:US
Mailing Address - Phone:313-581-4010
Mailing Address - Fax:
Practice Address - Street 1:10335 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1658
Practice Address - Country:US
Practice Address - Phone:313-581-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-12-16
Deactivation Date:2024-10-01
Deactivation Code:
Reactivation Date:2024-12-10
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5302416824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program