Provider Demographics
NPI:1104878107
Name:ZUREICK, SAMIR
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:ZUREICK
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 1:28495 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5438
Mailing Address - Country:US
Mailing Address - Phone:586-573-9030
Mailing Address - Fax:586-573-6576
Practice Address - Street 1:28495 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5438
Practice Address - Country:US
Practice Address - Phone:586-573-9030
Practice Address - Fax:586-573-6576
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISZ050459174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA78621Medicare UPIN
MIP28630001Medicare ID - Type UnspecifiedGROUP ID