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General NPI Number Information
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NPI Number | 1942039318
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Entity Type | Individual
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Provider Name | SAMUEL COLT FARLEY
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Gender | Male
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 2600 N MAYFAIR RD STE 580
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City | MILWAUKEE
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State | WI
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Zip | 53226-1321
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Country | US
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Telephone | 414-732-2715
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Fax | 414-476-3242
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Provider Business Mailing Address
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Address Line | 2600 N MAYFAIR RD STE 580
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City | MILWAUKEE
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State | WI
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Zip | 53226-1321
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Country | US
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Telephone | 414-476-0430
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8181-23
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License Number State | WI
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