Individual
SAMIR DAVID DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5301 MCAULEY DR, YPSILANTI, MI 48197-1051
(734) 712-3456
Mailing address
251 E HURON ST, CHICAGO, IL 60611-3055
(312) 962-2000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
125.075921
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2020
Last updated
10/16/2024
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