Provider Demographics
NPI:1366547143
Name:BAHU, SAMER J (MD)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:J
Last Name:BAHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2985
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2985
Practice Address - Country:US
Practice Address - Phone:248-334-9490
Practice Address - Fax:248-636-1170
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068016207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH62716Medicare UPIN
MIOM90080Medicare ID - Type UnspecifiedMEDICARE