Provider Demographics
NPI:1467494161
Name:DOLA, SAMER ABOU (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:ABOU
Last Name:DOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMER
Other - Middle Name:
Other - Last Name:ABOUDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1300 N PROSPECT AVE
Mailing Address - Street 2:APT. 411
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3022
Mailing Address - Country:US
Mailing Address - Phone:216-255-8969
Mailing Address - Fax:
Practice Address - Street 1:8901 W LINCOLN AVE
Practice Address - Street 2:GREAT LAKES PATHOLOGIST, S.C.
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2409
Practice Address - Country:US
Practice Address - Phone:414-649-6831
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology