MEDICARE: DR. PETER AIAD SAMUEL MD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	125060136	IL
2	207Q00000X	Family Medicine Physician	ME132116	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548556715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER AIAD SAMUEL MD, MBA

Provider Business Mailing Address
First Line	:	3702 W SPRUCE ST # 1577
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2553
Country	:	US
Telephone Number	:	328-953-3633
Fax Number	:	332-895-3363

Provider Business Practice Location Address
First Line	:	3702 W SPRUCE ST # 1577
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2553
Country	:	US
Telephone Number	:	328-953-3633
Fax Number	:	332-895-3363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2011
Last Update Date	:	06/18/2025

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