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NPI Code Detail

MEDICARE: DR. SAMI K BADDOURA M.D.

MEDICARE: DR. SAMI K BADDOURA 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
1207RI0011XInterventional Cardiology PhysicianME74228FL
2207RC0000XCardiovascular Disease PhysicianME0074228FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588668156
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMI K BADDOURA M.D.
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line : ATTN: MEDICAL STAFF OFFICE
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3525 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-1965
Country : US
Telephone Number : 863-284-5020
Fax Number : 863-284-5912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 11/21/2022

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