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General NPI Number Information
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NPI Number | 1174901573
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Entity Type | Individual
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Provider Name | SAMER KAWAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 355 WESTFIELD RD STE 130
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City | NOBLESVILLE
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State | IN
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Zip | 46060-1442
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Country | US
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Telephone | 317-776-8748
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Fax | 317-773-0314
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Provider Business Mailing Address
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Address Line | PO BOX 843022
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City | KANSAS CITY
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State | MO
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Zip | 64184-3022
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Country | US
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Telephone | 317-770-6900
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Fax | 317-770-6911
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 01087684A
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License Number State | IN
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