Provider Demographics
NPI:1083874481
Name:SAMARA SERVICES LLC
Entity Type:Organization
Organization Name:SAMARA SERVICES LLC
Other - Org Name:HOUSE CALL MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:YOUSEF
Authorized Official - Last Name:SAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-247-9005
Mailing Address - Street 1:P O BOX 639
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-0639
Mailing Address - Country:US
Mailing Address - Phone:414-247-9005
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:5301 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5019
Practice Address - Country:US
Practice Address - Phone:414-247-9005
Practice Address - Fax:414-247-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32170400Medicaid
000173606OtherMEDICARE PTAN INDIDUAL
000073606OtherMEDICARE PTAN GROUP
BS4635263OtherDEA