Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 4301061347 | MI |
NPI | 1679565584 |
---|---|
Provider Name | Samson P Samuel |
First Address | Warren, MI 48093-5266 |
Second Address | Warren, MI 48093-2572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3258892 | (05) | MI |
F33847 | (02) | |
SS061347 | BCBS PIN # (01) | MI |