Provider Demographics
NPI:1720270838
Name:TAMMO, SAMI (MD)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:TAMMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01852207R00000X
KY43465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182YKOtherBCBS
NC9958748OtherAETNA
NC1720270838OtherTRICARE
NC272341OtherMEDCOST
NC1720270838Medicaid
VA1720270838OtherVIRGINIA MEDICAID
SCQ01852OtherSOUTH CAROLINA MEDICAID
NC3345588OtherUNITED HEALTHCARE
VA1720270838OtherVIRGINIA MEDICAID