Provider Demographics
NPI:1629156146
Name:SAMEH, MAYSA (MD)
Entity Type:Individual
Prefix:
First Name:MAYSA
Middle Name:
Last Name:SAMEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 - 15TH AVE.
Mailing Address - Street 2:STE. 180
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1160
Mailing Address - Country:US
Mailing Address - Phone:414-768-5430
Mailing Address - Fax:414-762-4225
Practice Address - Street 1:14555 W. NATIONAL AVE.
Practice Address - Street 2:STE. 165
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4494
Practice Address - Country:US
Practice Address - Phone:262-827-2959
Practice Address - Fax:262-827-2948
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44459-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0006Medicare PIN
WI02120-0143Medicare PIN