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NPI Code Detail

MEDICARE: SAMA SHAH

MEDICARE: SAMA SHAH
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1114716479
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMA SHAH
Provider Business Mailing Address
First Line : 945 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1305
Country : US
Telephone Number : 414-219-7136
Fax Number :
Provider Business Practice Location Address
First Line : 945 N 12TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1305
Country : US
Telephone Number : 414-219-7136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2025
Last Update Date : 03/22/2026

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Directions to “ SAMA SHAH ” Practice Location

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