Provider Demographics
NPI:1821356064
Name:SAMUEL, LINU VARUGHESE (MD)
Entity Type:Individual
Prefix:
First Name:LINU
Middle Name:VARUGHESE
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8471 GULF FREEWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-4658
Mailing Address - Country:US
Mailing Address - Phone:832-709-2770
Mailing Address - Fax:832-924-0113
Practice Address - Street 1:8471 GULF FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-4658
Practice Address - Country:US
Practice Address - Phone:832-709-2770
Practice Address - Fax:832-924-0113
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9725207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400244381Medicare PIN