Provider Demographics
NPI:1457361065
Name:ESSMA, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:ESSMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WESTPORT PLAZA DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:ALTON MEMORIAL HOSPITAL
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7415
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360847612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1390OtherMO BLUE
431725842MIDOtherMERCY
225826OtherHLINK
2781OtherGHP
46033OtherHCARE USA
300066977OtherRR MEDICARE
300066982OtherRR MEDICARE
F42701OtherGATEWAY
136331OtherBLUE CHOICE
1600001OtherPH PLAN
300066972OtherRR MEDICARE
0006021895OtherIL BLUE
IL0360847611Medicaid
300066OtherHLT PART
ILL40195Medicare PIN
F42701OtherGATEWAY
ILL40195Medicare ID - Type Unspecified