Provider Demographics
NPI:1336238831
Name:NALINI SAMUEL MD PC
Entity Type:Organization
Organization Name:NALINI SAMUEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:NALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-385-7700
Mailing Address - Street 1:3050 KRAFFT RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3821
Mailing Address - Country:US
Mailing Address - Phone:810-385-7700
Mailing Address - Fax:810-385-7760
Practice Address - Street 1:3050 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3821
Practice Address - Country:US
Practice Address - Phone:810-385-7700
Practice Address - Fax:810-385-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G41016OtherBLUE CROSS BLUE SHIELD
0G41016OtherBLUE CROSS BLUE SHIELD