Waggoner, Samina M

Waggoner, Samina M is an individual health care provider with primary practice located at 718 Glenview Ave Highland Park Hospital, Highland Park IL 60035. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Waggoner, Samina M can be contacted via phone (847) 480-2833.

Contact Information

Primary practice address
718 Glenview Ave Highland Park Hospital Highland Park IL 60035
Phone: (847) 480-2833
Fax: (847) 480-2675
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036112866 Illinois

Profile Details

NPI number 1750350948
LBN Legal business name Waggoner, Samina M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 17th, 2006
Last updated Jul 17th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750350948 NPPES
Illinois Other 021622158 GROUP BLUE SHIELD NUMBER
Illinois MEDICAID 036112866 GROUP BLUE SHIELD NUMBER

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