Provider Demographics
NPI:1861746935
Name:HADI, SAMIR S (MBCHB)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:S
Last Name:HADI
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:SAMIR
Other - Middle Name:S
Other - Last Name:HADI-TAMIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBCHB
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:1836 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5429
Practice Address - Country:US
Practice Address - Phone:608-782-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4613202085R0202X
COPENDING2085R0204X
390200000X
WI720162085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program