Healthcare Provider Details

I. General information

NPI: 1083874481
Provider Name (Legal Business Name): SAMARA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 W HAMPTON AVE
MILWAUKEE WI
53218-5019
US

IV. Provider business mailing address

P O BOX 639
THIENSVILLE WI
53092-0639
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-9005
  • Fax: 414-247-9004
Mailing address:
  • Phone: 414-247-9005
  • Fax: 414-247-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMAD YOUSEF SAMARA
Title or Position: MEMBER/OWNER
Credential: MD
Phone: 414-247-9005