1548235369 NPI number — MR. SAMIR AQEL ELIAN M.D.

Table of content: MR. SAMIR AQEL ELIAN M.D. (NPI 1548235369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548235369 NPI number — MR. SAMIR AQEL ELIAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELIAN
Provider First Name:
SAMIR
Provider Middle Name:
AQEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548235369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5336 TIMBERWOOD POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-230-9082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-720-3370
Provider Business Practice Location Address Fax Number:
810-720-3367
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  4301075121 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 138398 . This is a "PREFERRED CHOICE PPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E91688 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0998649 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 320112688 . This is a "TRICARE/HEALTH NET" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N95010 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 320112688 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00164039 . This is a "PALMETTO GBA RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 16457 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4618140 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5917178 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0251107 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 320112688 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7379343 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0602511071 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1010990 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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