Provider Demographics
NPI:1851352272
Name:HO, SAM U (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:U
Last Name:HO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:175 E DELAWARE PL APT 5023
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7717
Mailing Address - Country:US
Mailing Address - Phone:312-787-9499
Mailing Address - Fax:312-787-9498
Practice Address - Street 1:259 E ERIE ST STE 1900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3246
Practice Address - Country:US
Practice Address - Phone:312-695-7950
Practice Address - Fax:312-695-5747
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0493782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130000480OtherRR MEDICARE
IL216-09854-34OtherBC/BS
R014672OtherCHAMPUS
IL638431OtherPTAN
ILD14191Medicare UPIN
IL638-431Medicare ID - Type Unspecified