Provider Demographics
NPI:1386020634
Name:SAMUELS, MAURICE LEON
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:LEON
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5075 WILLOUGHBY RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1054
Mailing Address - Country:US
Mailing Address - Phone:517-803-8970
Mailing Address - Fax:
Practice Address - Street 1:1032 WILLOW HWY
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2064
Practice Address - Country:US
Practice Address - Phone:517-803-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health