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NPI Code Detail

MEDICARE: RANDA SHAHER SAMRAH MD

MEDICARE: RANDA SHAHER SAMRAH MD
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
1207R00000XInternal Medicine Physician125087098IL

General Provider Information

NPI Number : 1578419065
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDA SHAHER SAMRAH MD
Provider Business Mailing Address
First Line : 2320 COLORADO AVE
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-2554
Country : US
Telephone Number : 319-936-8678
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1782
Country : US
Telephone Number : 319-936-8678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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