Provider Demographics
NPI:1104878248
Name:LOLEH, SAMER (MD)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:LOLEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMER
Other - Middle Name:
Other - Last Name:LOLEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:220 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2838
Mailing Address - Country:US
Mailing Address - Phone:931-684-2802
Mailing Address - Fax:877-671-2402
Practice Address - Street 1:220 W CEDAR ST STE 208
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2838
Practice Address - Country:US
Practice Address - Phone:931-684-2802
Practice Address - Fax:877-671-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505186Medicaid
TNH89957Medicare UPIN
TN1031379686Medicare NSC