Basic Information
| Provider Information | |||||||||
| NPI: | 1811254394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITRI | ||||||||
| FirstName: | SAMI | ||||||||
| MiddleName: | HANNAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3955 PATIENT CARE DR STE A | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489114271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173747600 | ||||||||
| FaxNumber: | 5173741126 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037308900 | ||||||||
| FaxNumber: | 3037387755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101020079 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DR.0061321 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | DR.0061321 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.