Provider Demographics
NPI:1790914828
Name:MORKER, SAMIP (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMIP
Middle Name:
Last Name:MORKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0631
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:830 N ASHLAND AVE
Practice Address - Street 2:1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-280-7001
Practice Address - Fax:773-280-5797
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132196207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12729810OtherCAQH
IN201262120AMedicaid
IN12729810OtherCAQH