Provider Demographics
NPI:1710985395
Name:SAMPLES, KAREN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2322
Mailing Address - Country:US
Mailing Address - Phone:734-675-4514
Mailing Address - Fax:734-692-8883
Practice Address - Street 1:3290 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2322
Practice Address - Country:US
Practice Address - Phone:734-675-4514
Practice Address - Fax:734-692-8883
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1158202445OtherBCBS
MI7155295OtherMIDWEST
MI4461140Medicaid
MIP00068341OtherRAILROAD MEDICARE
MI1710985395Medicaid
MIE85113OtherHAP
MI4100137OtherAETNA
MI4100137OtherAETNA
MI0N62230Medicare PIN