MEDICARE: SAMIULLAH KARIM

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	172A00000X	Driver	K65078098221	IL

General Provider Information

NPI Number	:	1235000753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIULLAH KARIM

Provider Business Mailing Address
First Line	:	559 GREGORY AVE APT 2D
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-7534
Country	:	US
Telephone Number	:	630-457-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 GREGORY AVE APT 2D
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-7534
Country	:	US
Telephone Number	:	630-457-8029
Fax Number	:

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

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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