Provider Demographics
NPI:1881694115
Name:FLASTER, SAMUEL L (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:FLASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W HIGGINS RD STE 505
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2045
Mailing Address - Country:US
Mailing Address - Phone:847-252-4103
Mailing Address - Fax:
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 2300B
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-843-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-043390208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043390Medicaid
ILK27752Medicare PIN
ILC42150Medicare UPIN