Basic Information
| Provider Information | |||||||||
| NPI: | 1174901573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAWAK | ||||||||
| FirstName: | SAMER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 N ROCHESTER RD APT 14 | ||||||||
| Address2: | |||||||||
| City: | CLAWSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480171756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179037941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 W 13 MILE RD | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480736712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488985000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301107047 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.