Provider Demographics
NPI:1790418424
Name:DOW, SAMUEL D
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:DOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 S MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3281
Mailing Address - Country:US
Mailing Address - Phone:734-678-1106
Mailing Address - Fax:
Practice Address - Street 1:1113 S MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3281
Practice Address - Country:US
Practice Address - Phone:734-678-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator