Individual
MICHAEL BOUSAMRA II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19229 MACK AVE STE 23, GROSSE POINTE WOODS, MI 48236-2857
(248) 849-2600
(248) 849-2610
Mailing address
16001 W 9 MILE RD FL 3, SOUTHFIELD, MI 48075-4818
(248) 849-2600
(248) 849-2610
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01066681A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35096
KY
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301503387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200204120
—
IN
05
—
64010325
—
KY
Enumeration date
06/05/2006
Last updated
12/11/2020
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