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NPI Code Detail

MEDICARE: JOHN SAMAHA

MEDICARE: JOHN SAMAHA
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
1101YP2500XProfessional Counselor7652-125WI

General Provider Information

NPI Number : 1699314997
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN SAMAHA
Provider Business Mailing Address
First Line : 1518 11TH ST STE 1-4
Second Line :
City : MONROE
State : WI
Zip : 53566-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1518 11TH ST STE 1-4
Second Line :
City : MONROE
State : WI
Zip : 53566-1701
Country : US
Telephone Number : 608-325-1070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2020
Last Update Date : 01/03/2020

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Directions to “ JOHN SAMAHA ” Practice Location

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