MEDICARE: WALID SAMAAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01042568A	IN
2	207RP1001X	Pulmonary Disease Physician	01042568	IN
3	207RP1001X	Pulmonary Disease Physician	MD449780	PA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD449780	PA
5	207RP1001X	Pulmonary Disease Physician	35.060505	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000991174	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1093719502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALID SAMAAN M.D.

Provider Business Mailing Address
First Line	:	2723 S 7TH STREET
Second Line	:	SUITE A
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-3558
Country	:	US
Telephone Number	:	812-238-1730
Fax Number	:	812-242-1565

Provider Business Practice Location Address
First Line	:	1040 SIERRA DR
Second Line	:	SUITE 400
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7240
Country	:	US
Telephone Number	:	317-528-4270
Fax Number	:	317-865-8336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/22/2016

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Directions to “ WALID SAMAAN M.D.” Practice Location

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