Provider Demographics
NPI:1083716757
Name:SAMUELS, CHRISTIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:L
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2029
Mailing Address - Country:US
Mailing Address - Phone:810-653-4145
Mailing Address - Fax:810-653-1741
Practice Address - Street 1:8020 DAVISON RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2029
Practice Address - Country:US
Practice Address - Phone:810-653-4145
Practice Address - Fax:810-653-1741
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4179710Medicaid
MI4179710Medicaid
MIM23560117Medicare PIN