Provider Demographics
NPI:1770519936
Name:GIRGIS, SAMUEL J (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N ELM ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3635
Mailing Address - Country:US
Mailing Address - Phone:630-323-5214
Mailing Address - Fax:630-323-5297
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-323-5214
Practice Address - Fax:630-323-5297
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004111211OtherAETNA
IL0004111211OtherAETNA
ILK01468Medicare ID - Type UnspecifiedMEDICARE LOCATION 99
IL401350Medicare ID - Type UnspecifiedMEDICARE LOCATION 16
IL774590Medicare ID - Type UnspecifiedMEDICARE LOCATION 15