MEDICARE: MR. JAMAL-EDDIN DAHER PA-C

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	363A00000X	Physician Assistant	PA66166	CA

General Provider Information

NPI Number	:	1134870827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMAL-EDDIN DAHER PA-C

Provider Business Mailing Address
First Line	:	3927 S HOWELL AVE STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4421
Country	:	US
Telephone Number	:	414-295-9611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3927 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4421
Country	:	US
Telephone Number	:	414-295-9611
Fax Number	:

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

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	09/18/2025

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