MEDICARE: DR. SAMI A ROUMANI 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
1	207Q00000X	Family Medicine Physician	34275	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	391817459012	OTHER	WI	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1306936414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMI A ROUMANI M.D.

Provider Business Mailing Address
First Line	:	3046 S 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3826
Country	:	US
Telephone Number	:	414-649-9696
Fax Number	:	414-649-9698

Provider Business Practice Location Address
First Line	:	3046 S 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3826
Country	:	US
Telephone Number	:	414-649-9696
Fax Number	:	414-649-9698

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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