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NPI Code Detail

MEDICARE: DR. SAM J BADRAN MD

MEDICARE: DR. SAM J BADRAN 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
1207VG0400XGynecology Physician30366WV

General Provider Information

NPI Number : 1639745201
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAM J BADRAN MD
Provider Business Mailing Address
First Line : 4433 ROSLYN RD
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-5804
Country : US
Telephone Number : 773-818-2692
Fax Number :
Provider Business Practice Location Address
First Line : 2520 VALLEY DR
Second Line :
City : POINT PLEASANT
State : WV
Zip : 25550-2092
Country : US
Telephone Number : 304-675-4340
Fax Number : 304-675-6911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2021
Last Update Date : 06/03/2021

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