Provider Demographics
NPI:1639745201
Name:BADRAN, SAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:J
Last Name:BADRAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4433 ROSLYN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5804
Mailing Address - Country:US
Mailing Address - Phone:773-818-2692
Mailing Address - Fax:
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2092
Practice Address - Country:US
Practice Address - Phone:304-675-4340
Practice Address - Fax:304-675-6911
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV30366207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology