Bousamra, Michael

Bousamra, Michael is an individual health care provider with primary practice located at 19229 Mack Ave Ste 23 , Grosse Pointe Woods MI 48236-2857. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Bousamra, Michael can be contacted via phone (248) 849-2600.

Contact Information

Primary practice address
19229 Mack Ave Ste 23 Grosse Pointe Woods MI 48236-2857
Phone: (248) 849-2600
Fax: (248) 849-2610
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 01066681A Indiana
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 35096 Kentucky
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 4301503387 Michigan

Profile Details

NPI number 1669411781
LBN Legal business name Bousamra, Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2006
Last updated Dec 11th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669411781 NPPES
Indiana MEDICAID 200204120
Indiana MEDICAID 64010325

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