Provider Demographics
NPI:1578500666
Name:NASSER, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400 - CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-581-5846
Mailing Address - Fax:248-581-5642
Practice Address - Street 1:1560 E MAPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1138
Practice Address - Country:US
Practice Address - Phone:248-581-5846
Practice Address - Fax:248-581-5642
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630903Medicare PIN