Basic Information
| Provider Information | |||||||||
| NPI: | 1538195664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DABBOUS | ||||||||
| FirstName: | SAMIR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26901 BEAUMONT BLVD STE 3D | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480333849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9475221863 | ||||||||
| FaxNumber: | 9475220307 | ||||||||
| Practice Location | |||||||||
| Address1: | 22060 BEECH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132280505 | ||||||||
| FaxNumber: | 3132280506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301038418 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 4301038418 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207UN0901X | 4301038418 | MI | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 4301038418 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060007967 | 01 | MI | MEDICARE RR | OTHER | 0Q26305001 | 01 | MI | BLUECROSSBLUESHIELD OF MI | OTHER | 1572450 | 05 | MI | MEDICAID | P41685 | 01 | MI | BLUECARENETWORK | OTHER |