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1336776061

NPI Code Detail

MEDICARE: DR. SAMUEL KAMOROFF MD

MEDICARE: DR. SAMUEL KAMOROFF 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	01099457A	IN
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	036.180109	IL
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	61690	KY
4	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	75539	AZ

General Provider Information

NPI Number	:	1336776061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL KAMOROFF MD

Provider Business Mailing Address
First Line	:	1919 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7710
Country	:	US
Telephone Number	:	602-546-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7710
Country	:	US
Telephone Number	:	602-933-1000
Fax Number	:

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	05/26/2026

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Directions to “ DR. SAMUEL KAMOROFF MD” Practice Location

Language	Start Address	Practice Location

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