Provider Demographics
NPI:1386152296
Name:SAMUELSON ENTERPRISES, PLLC
Entity type:Organization
Organization Name:SAMUELSON ENTERPRISES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:BENSSON
Authorized Official - Middle Name:VARGHESE
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, DBA, EDD
Authorized Official - Phone:248-792-9864
Mailing Address - Street 1:545 ASHMUN ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1936
Mailing Address - Country:US
Mailing Address - Phone:202-262-2218
Mailing Address - Fax:
Practice Address - Street 1:3930 MOUNT VERNON DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3226
Practice Address - Country:US
Practice Address - Phone:202-262-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2050X, 207RH0005X, 207RN0300X, 207T00000X, 251E00000X, 305S00000X, 3336H0001X, 261QE0700X, 343800000X, 207P00000X, 207RC0000X
MI251G00000X, 261QC1800X, 261QI0500X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care CampGroup - Multi-Specialty
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension SpecialistGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Multi-Specialty
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710240403Medicaid