Provider Demographics
NPI:1548556715
Name:SAMUEL, PETER AIAD (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:AIAD
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:211 E ONTARIO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3468
Mailing Address - Country:US
Mailing Address - Phone:312-926-9512
Mailing Address - Fax:312-926-6274
Practice Address - Street 1:211 E ONTARIO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3468
Practice Address - Country:US
Practice Address - Phone:312-926-9512
Practice Address - Fax:312-926-6274
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125060136207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine