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NPI Code Detail

MEDICARE: SAMARA TAHER M.D.

MEDICARE: SAMARA TAHER 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
1207Q00000XFamily Medicine Physician036122013IL

General Provider Information

NPI Number : 1295902286
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMARA TAHER M.D.
Provider Business Mailing Address
First Line : 680 N LAKE SHORE DR
Second Line : SUITE 1000
City : CHICAGO
State : IL
Zip : 60611-3092
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1135 S DELANO CT E
Second Line : #A201
City : CHICAGO
State : IL
Zip : 60605-3457
Country : US
Telephone Number : 312-926-3627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 11/12/2016

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