MEDICARE: SAMIR N. SALAMA MD

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	207R00000X	Internal Medicine Physician	44077	MN

General Provider Information

NPI Number	:	1255390498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIR N. SALAMA MD

Provider Business Mailing Address
First Line	:	3100 KENNARD ST STE 100
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5466
Country	:	US
Telephone Number	:	651-232-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 KENNARD ST STE 100
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5466
Country	:	US
Telephone Number	:	651-232-5757
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/05/2015

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