MEDICARE: WALEED SALAH SAMARA PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1710845029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALEED SALAH SAMARA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	17551 KELSEY LN
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-8561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17551 KELSEY LN
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-8561
Country	:	US
Telephone Number	:	708-897-1724
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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