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NPI Code Detail

MEDICARE: SAMRA KHALID DO

MEDICARE: SAMRA KHALID DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician25MB09964800NJ

General Provider Information

NPI Number : 1467795476
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMRA KHALID DO
Provider Business Mailing Address
First Line : 328 LINDEN AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-2895
Country : US
Telephone Number : 847-475-1224
Fax Number : 847-475-0150
Provider Business Practice Location Address
First Line : 328 LINDEN AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-2895
Country : US
Telephone Number : 847-475-1224
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 06/11/2024

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Directions to “ SAMRA KHALID DO” Practice Location

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