Basic Information
| Provider Information | |||||||||
| NPI: | 1588799100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER HILLS HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2840 CROOKS RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483093619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488529290 | ||||||||
| FaxNumber: | 2488520305 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 GROSSE PINES DR | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483091828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486522363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAMY | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | DEVA | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2488529290 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD MS MPH MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301061131 | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.