Provider Demographics
NPI:1598480881
Name:CARRAO, SAMUEL ANDREW
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ANDREW
Last Name:CARRAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3026
Mailing Address - Country:US
Mailing Address - Phone:414-378-2112
Mailing Address - Fax:
Practice Address - Street 1:5952 S PACKARD AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3026
Practice Address - Country:US
Practice Address - Phone:414-378-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider