Individual
SAMUEL D. PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(608) 263-8114
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
46961
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34888900
—
WI
01
—
P00383765
RAIL ROAD MEDICARE
—
Enumeration date
04/20/2006
Last updated
12/20/2021
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