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General NPI Number Information
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NPI Number | 1245467554
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Entity Type | Individual
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Provider Name | MR. KENNY E SAMUEL
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Gender | Male
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 6621 N YUBA ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-5759
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Country | US
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Telephone | 414-406-1438
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Fax | 414-353-5633
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Provider Business Mailing Address
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Address Line | PO BOX 090374
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City | MILWAUKEE
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State | WI
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Zip | 53209-0374
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Country | US
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Telephone | 414-406-1438
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Fax | 414-353-5633
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 41488300
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License Number State | WI
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