Provider Demographics
NPI:1194997338
Name:BAKHOS, SAMER (MD)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:BAKHOS
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 1:21333 HAGGERTY RD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5514
Mailing Address - Country:US
Mailing Address - Phone:800-979-9595
Mailing Address - Fax:248-662-9845
Practice Address - Street 1:7534 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-3437
Practice Address - Country:US
Practice Address - Phone:800-979-9595
Practice Address - Fax:248-662-9845
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204682208M00000X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073075Medicaid
LA1073075Medicaid
LA1194997338OtherNPI