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General NPI Number Information
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NPI Number | 1467680942
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Entity Type | Individual
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Provider Name | SAMER AJAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 1500 S LAKE PARK AVE STE 110
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City | HOBART
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State | IN
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Zip | 46342-6638
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Country | US
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Telephone | 219-947-6017
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Fax | 219-947-6018
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Provider Business Mailing Address
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Address Line | 405 WESSEX RD
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City | VALPARAISO
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State | IN
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Zip | 46385-7716
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Country | US
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Telephone | 219-309-9353
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Fax |
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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 | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 01069863A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01069863A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01069863A
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License Number State | IN
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